go back

Vermont rates for HCPCS 21085

Impression & Preparation Oral Surgical Splint

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$571.60 / $738.50 / $931.34
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$645.62 / $1,023.51 / $1,592.51
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$768.78 / $1,060.15 / $1,592.51
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$871.89 / $1,000.23 / $2,907.74