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Washington, DC rates for HCPCS 21085

Impression and custom preparation; oral surgical splint

Facilitymedian $1,698 · 10th–90th $490$7,7620%10%10th90th$1,698Professionalmedian $692 · 10th–90th $479$1,8620%10%10th90th$692$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
$489.78 / $1,698.24 / $7,762.47
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$478.63 / $691.83 / $1,862.09
CareFirst
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$524.81 / $645.65 / $2,041.74
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$489.78 / $851.14 / $1,862.09
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$758.58 / $1,071.52 / $1,548.82
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$165.96 / $549.54 / $1,548.82
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$478.63 / $851.14 / $1,659.59