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Indiana rates for HCPCS 21085

Impression & Preparation Oral Surgical Splint

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$457.42 / $635.86 / $4,846.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$447.93 / $618.89 / $792.91
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$943.62 / $943.62 / $943.62
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$856.00 / $4,320.00 / $8,230.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$494.83 / $728.58 / $983.58
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$448.95 / $583.64 / $845.87
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$629.08 / $754.90 / $943.62
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$166.36 / $166.36 / $197.20
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$544.66 / $764.35 / $1,293.28
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$933.00 / $2,252.00 / $4,426.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$572.36 / $777.99 / $1,378.25