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New Hampshire rates for HCPCS 21085

Impression & Preparation Oral Surgical Splint

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $2,022.32 / $2,444.57
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$526.67 / $723.73 / $902.56
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,223.09 / $1,359.00 / $3,300.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$475.82 / $792.72 / $1,202.08
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$835.51 / $835.51 / $835.51
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$682.20 / $1,089.57 / $1,996.43
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$582.02 / $1,042.83 / $1,938.02
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,448.00 / $7,448.00 / $7,448.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$775.67 / $1,054.77 / $1,965.58
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$400.73 / $611.38 / $783.78