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Iowa rates for HCPCS 21085

Impression and custom preparation; oral surgical splint

Facilitymedian $1,202 · 10th–90th $562–$6,4570%5%10%10th90th$1,202Professionalmedian $724 · 10th–90th $479–$1,7380%10%10th90th$724$100.0$200.0$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
$776.25 / $5,011.87 / $7,943.28
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$478.63 / $707.95 / $1,737.80
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$724.44 / $1,412.54 / $2,041.74
Hally Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$489.78 / $851.14 / $1,445.44
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$501.19 / $1,202.26 / $1,949.84
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$741.31 / $1,412.54 / $4,265.80
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,202.26 / $1,513.56 / $1,819.70
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,230.27 / $1,513.56 / $1,819.70
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$354.81 / $741.31 / $2,344.23
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$549.54 / $891.25 / $1,698.24
Wellmark
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$933.25 / $1,122.02 / $1,548.82