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Illinois rates for HCPCS 21085

Impression and custom preparation; oral surgical splint

Facilitymedian $1,380 · 10th–90th $479–$7,7620%5%10th90th$1,380Professionalmedian $776 · 10th–90th $479–$1,3800%10%10th90th$776$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
$630.96 / $1,445.44 / $7,762.47
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$478.63 / $724.44 / $1,380.38
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$302.00 / $407.38 / $10,471.29
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$575.44 / $794.33 / $1,380.38
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$239.88 / $239.88 / $239.88
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$537.03 / $812.83 / $1,445.44
Hally Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$630.96 / $1,047.13 / $2,187.76
Hally Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$100.00 / $100.00 / $100.00
Hally Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$588.84 / $616.60 / $933.25
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $32.36 / $891.25
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$204.17 / $691.83 / $2,089.30
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$537.03 / $794.33 / $1,258.93