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Wyoming rates for HCPCS 21085

Impression & Preparation Oral Surgical Splint

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$486.33 / $694.12 / $698.28
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$261.00 / $261.00 / $261.00
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$923.00 / $1,304.00 / $1,972.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$785.66 / $1,132.93 / $1,912.50
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$293.00 / $293.00 / $3,239.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$983.43 / $1,397.94 / $2,516.80