go back

Rhode Island rates for HCPCS 21085

Impression & Preparation Oral Surgical Splint

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,706.14 / $3,706.14 / $3,955.04
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$475.53 / $723.73 / $1,146.03
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$494.59 / $701.65 / $1,309.20
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$638.67 / $1,033.33 / $1,401.07
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$540.00 / $1,401.00 / $4,915.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$614.24 / $1,000.09 / $1,593.60