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Maryland rates for HCPCS 21085

Impression & Preparation Oral Surgical Splint

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$469.96 / $663.71 / $1,779.41
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$532.64 / $551.17 / $718.56
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$117.19 / $507.00 / $641.21
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$494.51 / $846.03 / $1,555.18
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$713.25 / $920.09 / $1,216.19
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$36.00 / $36.00 / $41.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$514.79 / $756.28 / $1,438.40
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$502.64 / $820.24 / $1,019.31