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Connecticut rates for HCPCS 21085

Impression & Preparation Oral Surgical Splint

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$853.67 / $4,722.42 / $10,492.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$499.50 / $720.80 / $1,714.18
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,410.00 / $6,763.00 / $10,432.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$499.67 / $980.60 / $1,651.06
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$340.11 / $340.11 / $843.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$787.79 / $1,135.82 / $1,617.76
ConnectiCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,330.14 / $4,873.00 / $4,974.00
ConnectiCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$589.09 / $1,086.25 / $1,360.49
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,380.00 / $3,075.00 / $6,664.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$622.66 / $1,214.19 / $2,024.41