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North Dakota rates for HCPCS 21085

Impression and custom preparation; oral surgical splint

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$515.44 / $708.52 / $8,500.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$483.49 / $653.46 / $765.75
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,113.40 / $1,251.75 / $1,759.85
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$732.50 / $1,257.73 / $2,151.94
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$515.44 / $824.81 / $1,188.10
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$724.32 / $1,368.61 / $3,632.32
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$724.32 / $1,299.78 / $1,529.20