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Louisiana rates for HCPCS 21085

Impression & Preparation Oral Surgical Splint

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$630.33 / $1,369.79 / $3,884.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$508.36 / $797.24 / $1,120.47
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$212.78 / $549.71 / $4,536.54
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$615.39 / $847.85 / $1,297.24
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$422.72 / $627.12 / $627.12
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$400.00 / $400.00 / $400.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$525.82 / $831.82 / $1,253.93
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$194.00 / $543.00 / $1,560.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$593.94 / $800.66 / $1,410.81