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Hawaii rates for HCPCS 21085

Impression and custom preparation; oral surgical splint

Facilitymedian $2,818 · 10th–90th $1,072$2,8180%50%10th$2,818Professionalmedian $708 · 10th–90th $479$1,0720%10%10th90th$708$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. Small sample — interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,818.38 / $2,818.38 / $2,818.38
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$478.63 / $691.83 / $1,174.90
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$660.69 / $891.25 / $1,071.52
HMSA
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$794.33 / $954.99 / $1,071.52
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$467.74 / $812.83 / $977.24
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,071.52 / $1,071.52 / $1,071.52
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$630.96 / $776.25 / $891.25
University Health Alliance
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$117.49 / $616.60 / $933.25