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Utah rates for HCPCS 21085

Impression & Preparation Oral Surgical Splint

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$909.96 / $1,117.92 / $4,387.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$457.05 / $694.58 / $2,703.14
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$610.21 / $839.85 / $1,261.84
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$56.50 / $512.10 / $678.17
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$349.99 / $463.13 / $674.92
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$629.23 / $987.31 / $1,906.64
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,078.00 / $1,556.00 / $4,495.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$611.76 / $762.66 / $1,193.03