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Alaska rates for HCPCS 21085

Impression and custom preparation; oral surgical splint

Facilitymedian $1,023 · 10th–90th $525–$3,5480%5%10%10th90th$1,023Professionalmedian $871 · 10th–90th $513–$2,5700%10%10th90th$871$100.0$200.0$500.0$1.0K$2.0K$5.0K$10.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,513.56 / $9,772.37 / $16,595.87
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$489.78 / $724.44 / $1,737.80
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$501.19 / $1,230.27 / $2,290.87
Moda Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$537.03 / $1,023.29 / $3,311.31
Moda Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,000.00 / $1,862.09 / $3,467.37
Premera BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,949.84 / $2,754.23 / $3,801.89
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$524.81 / $1,000.00 / $3,311.31
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$60.26 / $977.24 / $1,778.28
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$199.53 / $199.53 / $199.53
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$562.34 / $1,819.70 / $3,801.89