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Idaho rates for HCPCS 21085

Impression & Preparation Oral Surgical Splint

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,500.00 / $4,500.00 / $5,519.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$515.44 / $879.98 / $1,390.92
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$149.02 / $149.02 / $149.44
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$667.91 / $877.66 / $1,202.09
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$502.25 / $1,070.14 / $1,599.56
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$785.10 / $1,107.46 / $1,342.38
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.34 / $966.38 / $1,215.77
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$440.33 / $586.41 / $967.46
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$819.20 / $1,152.53 / $1,388.65
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$150.00 / $1,800.00 / $9,193.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$809.55 / $1,083.79 / $1,650.04