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Arizona rates for HCPCS 21085

Impression and custom preparation; oral surgical splint

Facilitymedian $2,042 · 10th–90th $490–$5,6230%5%10%10th90th$2,042Professionalmedian $708 · 10th–90th $479–$1,9050%10%10th90th$708$100.0$200.0$500.0$1.0K$2.0K$5.0K

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
$912.01 / $3,467.37 / $7,585.78
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$467.74 / $691.83 / $1,949.84
Ambetter
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$676.08 / $676.08 / $676.08
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$416.87 / $1,862.09 / $3,388.44
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$575.44 / $831.76 / $1,778.28
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$512.86 / $741.31 / $1,318.26
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$489.78 / $776.25 / $1,698.24
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$616.60 / $933.25 / $5,128.61
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$199.53 / $933.25 / $2,137.96
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$489.78 / $676.08 / $1,122.02