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Kentucky rates for HCPCS 21085

Impression and custom preparation; oral surgical splint

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$407.81 / $687.97 / $2,747.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$457.42 / $620.04 / $723.73
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,013.00 / $8,584.00 / $11,253.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$483.03 / $582.15 / $777.10
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$446.56 / $635.71 / $733.34
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$495.22 / $636.85 / $908.16
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$630.39 / $835.51 / $835.51
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$584.83 / $810.23 / $1,202.28
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.34 / $327.22 / $687.97
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$50.00 / $668.00 / $3,176.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$615.85 / $890.45 / $1,378.25