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Idaho rates for HCPCS 21085

Impression and custom preparation; oral surgical splint

Facilitymedian $955 · 10th–90th $447$5,4950%5%10%10th90th$955Professionalmedian $891 · 10th–90th $525$1,3800%10%10th90th$891$50.0$200.0$1.0K$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
$4,466.84 / $5,495.41 / $5,495.41
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$489.78 / $794.33 / $1,380.38
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$407.38 / $741.31 / $1,513.56
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$851.14 / $1,000.00 / $1,380.38
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$147.91 / $147.91 / $147.91
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$562.34 / $851.14 / $1,174.90
Moda Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$501.19 / $933.25 / $1,584.89
Moda Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$707.95 / $1,071.52 / $1,412.54
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $32.36 / $33.11
Regence BlueShield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$436.52 / $588.84 / $776.25
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$812.83 / $1,023.29 / $1,412.54
Select Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$446.68 / $676.08 / $1,348.96
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$151.36 / $1,819.70 / $9,332.54
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$575.44 / $933.25 / $1,412.54