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Massachusetts rates for HCPCS 21085

Impression & Preparation Oral Surgical Splint

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$526.67 / $2,747.00 / $5,374.05
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$508.36 / $715.52 / $1,923.64
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$520.70 / $1,129.04 / $2,713.00
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$520.70 / $1,135.58 / $5,032.64
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$565.82 / $727.08 / $1,297.99
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$633.47 / $1,043.22 / $1,903.02
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$300.00 / $773.78 / $8,090.00
Fallon Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$793.83 / $961.59 / $1,319.51
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$602.52 / $1,306.86 / $1,882.57
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.00 / $1,818.00 / $3,445.00
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$781.44 / $1,498.06 / $5,032.64
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$627.00 / $1,818.00 / $2,733.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$724.32 / $1,091.78 / $2,153.35