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South Carolina rates for HCPCS 21085

Impression & Preparation Oral Surgical Splint

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$558.41 / $2,002.28 / $9,062.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$474.26 / $656.03 / $1,432.27
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,771.58 / $4,057.00 / $6,798.35
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$479.84 / $810.00 / $1,379.14
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$202.96 / $835.51 / $890.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$651.90 / $884.69 / $1,351.35
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$569.11 / $888.09 / $1,358.69
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$172.60 / $172.60 / $172.60
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$69.90 / $640.74 / $1,064.78
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$225.00 / $1,221.00 / $3,585.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$579.46 / $814.14 / $1,418.90