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Illinois rates for HCPCS 21085

Impression & Preparation Oral Surgical Splint

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$659.64 / $1,378.01 / $5,389.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$447.93 / $659.65 / $1,146.03
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$319.52 / $5,098.12 / $11,119.65
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$571.74 / $992.65 / $1,366.68
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$241.53 / $269.64 / $908.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$541.79 / $806.48 / $1,437.12
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$659.65 / $996.14 / $1,967.95
Hally Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$585.04 / $614.76 / $923.39
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.34 / $32.34 / $1,044.14
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$165.00 / $891.00 / $3,685.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$661.29 / $914.21 / $1,571.50