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Minnesota rates for HCPCS 21085

Impression & Preparation Oral Surgical Splint

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$483.49 / $689.07 / $689.07
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$483.49 / $689.07 / $1,117.92
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$384.25 / $792.68 / $4,060.75
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$913.53 / $1,586.17 / $2,395.46
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,687.87 / $2,394.84 / $5,761.12
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,022.17 / $1,694.90 / $2,935.03
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,534.43 / $2,189.46 / $4,536.31
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$986.74 / $1,583.45 / $2,676.30
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$601.60 / $981.56 / $1,727.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$796.75 / $1,435.83 / $3,632.32
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$382.00 / $1,727.00 / $2,883.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$795.81 / $1,360.26 / $2,661.87