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Missouri rates for HCPCS 21085

Impression and custom preparation; oral surgical splint

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$488.06 / $2,782.00 / $12,154.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$441.52 / $614.04 / $1,073.82
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,088.00 / $4,247.00 / $9,663.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$570.59 / $701.00 / $1,084.67
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$573.52 / $849.86 / $1,413.40
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$453.00 / $772.12 / $1,459.34
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$724.32 / $1,059.98 / $5,095.68
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$245.00 / $760.00 / $1,300.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$601.99 / $889.51 / $1,376.58