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West Virginia rates for HCPCS 21085

Impression & Preparation Oral Surgical Splint

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$474.92 / $741.90 / $1,400.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$474.92 / $642.97 / $1,011.36
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$478.79 / $521.05 / $625.98
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$389.13 / $556.42 / $556.42
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$835.51 / $835.51 / $835.51
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$517.77 / $884.94 / $2,129.77
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$543.28 / $795.28 / $1,113.39