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Connecticut rates for HCPCS 21085

Impression and custom preparation; oral surgical splint

Facilitymedian $4,677 · 10th–90th $912$10,4710%20%10th90th$4,677Professionalmedian $724 · 10th–90th $479$1,8200%10%10th90th$724$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
$912.01 / $4,677.35 / $10,471.29
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$467.74 / $707.95 / $1,778.28
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,137.96 / $3,162.28 / $11,748.98
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$562.34 / $1,174.90 / $1,819.70
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$354.81 / $354.81 / $851.14
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$630.96 / $1,096.48 / $1,698.24
ConnectiCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$851.14 / $1,148.15 / $1,445.44
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,288.25 / $3,981.07 / $7,079.46
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$501.19 / $891.25 / $1,778.28