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Maine rates for HCPCS 21085

Impression and custom preparation; oral surgical splint

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$505.08 / $651.49 / $893.32
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$541.98 / $647.28 / $919.45
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$632.22 / $936.28 / $1,354.28
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$606.35 / $855.32 / $1,518.11
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$514.61 / $651.49 / $893.32
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$606.35 / $993.76 / $1,374.21