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Colorado rates for HCPCS 21085

Impression and custom preparation; oral surgical splint

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$694.12 / $5,428.00 / $10,651.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$486.33 / $649.52 / $840.05
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,974.00 / $2,971.00 / $7,022.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$541.15 / $680.73 / $1,083.75
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$177.79 / $177.79 / $560.05
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$618.84 / $861.71 / $1,358.18
Denver HMP
Facility/Professional
Facility
Modifier
Low / Median / High Price
$567.97 / $833.57 / $1,136.69
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$611.53 / $859.05 / $1,237.03
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$730.00 / $1,491.00 / $2,720.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$756.00 / $1,003.50 / $1,564.31