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Massachusetts rates for HCPCS 21085

Impression and custom preparation; oral surgical splint

Facilitymedian $1,023 · 10th–90th $525$5,3700%10%10th90th$1,023Professionalmedian $832 · 10th–90th $501$1,8200%5%10%10th90th$832$100.0$500.0$2.0K$10.0K$50.0K

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
$524.81 / $2,818.38 / $5,623.41
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$489.78 / $707.95 / $1,778.28
AllWays Health Partners
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$56.23 / $1,122.02 / $3,019.95
AllWays Health Partners
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$512.86 / $912.01 / $2,290.87
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$562.34 / $562.34 / $1,288.25
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$537.03 / $1,000.00 / $1,819.70
Fallon Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$436.52 / $602.56 / $3,311.31
Fallon Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$812.83 / $977.24 / $1,380.38
Harvard Pilgrim
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$741.31 / $2,041.74 / $3,467.37
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$512.86 / $912.01 / $1,778.28
Mass General Brigham
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$56.23 / $1,122.02 / $3,019.95
Mass General Brigham
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$512.86 / $912.01 / $2,290.87
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$524.81 / $1,698.24 / $2,818.38
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$549.54 / $933.25 / $1,905.46