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Florida rates for HCPCS 21085

Impression & Preparation Oral Surgical Splint

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$508.36 / $3,276.00 / $11,550.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$474.26 / $625.32 / $874.79
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$122.01 / $123.98 / $323.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$459.69 / $776.31 / $1,363.44
Florida Blue
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,438.00 / $2,403.00 / $4,241.00
Florida Blue
Facility/Professional
Professional
Modifier
Low / Median / High Price
$357.97 / $659.64 / $792.13
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$69.66 / $641.34 / $972.86
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$366.00 / $1,950.00 / $5,107.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$533.98 / $774.30 / $1,328.44
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$375.58 / $529.79 / $529.79