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Maryland rates for HCPCS 21085

Impression and custom preparation; oral surgical splint

Facilitymedian $120 · 10th–90th $37–$6460%10%10th90th$120Professionalmedian $676 · 10th–90th $479–$1,3490%10%10th90th$676$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. Small sample — interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$467.74 / $660.69 / $1,479.11
CareFirst
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$478.63 / $524.81 / $724.44
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$120.23 / $512.86 / $645.65
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$562.34 / $812.83 / $1,479.11
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$758.58 / $851.14 / $1,288.25
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$36.31 / $40.74 / $660.69
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$478.63 / $741.31 / $1,288.25
Wellpoint
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$446.68 / $891.25 / $1,071.52