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New Mexico rates for HCPCS 21085

Impression & Preparation Oral Surgical Splint

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$691.37 / $3,495.24 / $7,838.38
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$494.96 / $628.37 / $858.27
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,737.86 / $6,372.37 / $10,383.68
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$405.23 / $767.41 / $1,212.38
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$618.84 / $945.08 / $1,360.27
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.34 / $115.55 / $962.98
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$560.70 / $777.37 / $1,117.92
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$639.35 / $1,007.30 / $1,489.30
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$230.00 / $1,158.00 / $1,401.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$739.20 / $1,058.40 / $1,583.99