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Delaware rates for HCPCS 21085

Impression and custom preparation; oral surgical splint

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,907.00 / $6,907.00 / $6,907.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$438.43 / $620.04 / $792.91
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$136.19 / $136.19 / $136.19
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$491.88 / $656.17 / $1,269.58
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$143.00 / $143.00 / $143.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$587.78 / $767.29 / $1,589.20