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Montana rates for HCPCS 21085

Impression and custom preparation; oral surgical splint

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$514.61 / $695.04 / $2,703.14
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$760.31 / $760.31 / $1,073.68
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$760.31 / $760.31 / $760.31
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$539.54 / $791.16 / $1,260.33
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$380.15 / $670.56 / $984.79
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$639.35 / $912.63 / $1,379.81
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$995.88 / $1,184.13 / $1,448.64