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Oklahoma rates for HCPCS 21085

Impression & Preparation Oral Surgical Splint

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,000.00 / $3,683.00 / $18,600.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$512.74 / $620.04 / $702.56
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,585.95 / $10,462.75 / $16,531.03
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$474.25 / $646.45 / $887.67
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$200.11 / $200.11 / $200.11
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$525.98 / $793.67 / $1,133.33
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$486.41 / $737.69 / $1,500.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$615.66 / $806.40 / $5,095.68
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$139.00 / $634.00 / $1,883.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$579.46 / $756.00 / $1,021.29