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Kansas rates for HCPCS 21085

Impression and custom preparation; oral surgical splint

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$801.44 / $3,843.00 / $12,154.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$488.06 / $678.63 / $1,079.81
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$713.21 / $839.07 / $1,097.57
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$624.00 / $624.00 / $624.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$591.28 / $855.99 / $1,394.01
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$432.32 / $794.00 / $1,659.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$725.90 / $956.73 / $5,095.68
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$191.00 / $550.00 / $1,769.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$651.89 / $829.10 / $1,167.76