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Tennessee rates for HCPCS 21085

Impression and custom preparation; oral surgical splint

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$608.08 / $2,678.00 / $7,602.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$444.36 / $629.65 / $1,056.14
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$764.00 / $1,522.00 / $2,257.00
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$581.50 / $856.33 / $1,331.08
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.00 / $30.00 / $30.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$597.59 / $863.38 / $1,418.08
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.00 / $2,420.51 / $2,420.51
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,591.60 / $5,032.64 / $5,753.85
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$294.00 / $795.00 / $2,577.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$615.66 / $848.09 / $1,485.70