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Indiana rates for HCPCS 21085

Impression and custom preparation; oral surgical splint

Facilitymedian $4,266 · 10th–90th $1,148–$8,3180%10%10th90th$4,266Professionalmedian $661 · 10th–90th $457–$1,5140%10%10th90th$661$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
$691.83 / $1,905.46 / $4,897.79
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$457.09 / $645.65 / $1,584.89
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,454.71 / $4,466.84 / $8,709.64
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$512.86 / $724.44 / $1,122.02
CareSource
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$446.68 / $501.19 / $562.34
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$524.81 / $794.33 / $1,548.82
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$512.86 / $741.31 / $1,348.96
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$199.53 / $2,137.96 / $7,413.10
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$478.63 / $707.95 / $1,202.26