go back

Ohio rates for HCPCS 21085

Impression and custom preparation; oral surgical splint

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$515.66 / $1,934.54 / $11,627.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$468.79 / $635.86 / $1,146.03
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$814.00 / $1,981.00 / $3,943.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$412.93 / $600.36 / $990.37
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$432.74 / $472.08 / $687.41
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$599.69 / $704.89 / $897.13
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$21,571.00 / $21,571.00 / $21,571.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$550.76 / $831.56 / $1,259.83
Medical Mutual of Ohio
Facility/Professional
Facility
Modifier
Low / Median / High Price
$835.51 / $835.51 / $835.51
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Low / Median / High Price
$555.39 / $842.72 / $1,259.83
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$67.28 / $616.72 / $908.85
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$444.00 / $965.00 / $2,914.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$507.02 / $819.44 / $1,377.60