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Louisiana rates for HCPCS 21085

Impression and custom preparation; oral surgical splint

Facilitymedian $1,259 · 10th–90th $355–$4,1690%5%10%10th90th$1,259Professionalmedian $692 · 10th–90th $479–$1,1220%10%10th90th$692$50.0$100.0$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. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$676.08 / $2,511.89 / $4,365.16
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$478.63 / $691.83 / $1,122.02
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$213.80 / $537.03 / $4,677.35
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$549.54 / $794.33 / $1,071.52
Christus
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$39.81 / $630.96 / $630.96
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$398.11 / $398.11 / $398.11
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$549.54 / $870.96 / $1,288.25
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$213.80 / $501.19 / $1,258.93
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$478.63 / $707.95 / $1,122.02