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California rates for HCPCS 21085

Impression and custom preparation; oral surgical splint

Facilitymedian $5,888 · 10th–90th $1,202$13,8040%10%10th90th$5,888Professionalmedian $776 · 10th–90th $490$2,5120%10%20%10th90th$776$50.0$200.0$1.0K$5.0K$20.0K$100.0K

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
$2,818.38 / $10,000.00 / $25,703.96
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$489.78 / $724.44 / $2,630.27
Ambetter
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$645.65 / $645.65 / $645.65
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$3,548.13 / $6,165.95 / $13,489.63
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$676.08 / $954.99 / $1,778.28
Blue Shield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$83.18 / $4,466.84 / $9,120.11
Blue Shield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$645.65 / $933.25 / $1,862.09
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$245.47 / $245.47 / $245.47
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$562.34 / $831.76 / $1,513.56
Contra Costa Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$478.63 / $645.65 / $1,096.48
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$436.52 / $741.31 / $1,348.96
Lucent Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$54.95 / $56.23 / $3,019.95
Lucent Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$5,011.87 / $5,754.40 / $5,754.40
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$575.44 / $575.44 / $954.99
Optum
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$54.95 / $54.95 / $70.79
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$512.86 / $831.76 / $1,288.25
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$562.34 / $831.76 / $1,513.56
Sutter Health Plus
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,659.59 / $1,659.59 / $2,344.23
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$549.54 / $1,548.82 / $6,456.54
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$446.68 / $691.83 / $1,412.54