go back

Michigan rates for HCPCS 21085

Impression and custom preparation; oral surgical splint

Facilitymedian $1,122 · 10th–90th $1–$4,8980%20%10th90th$1,122Professionalmedian $676 · 10th–90th $468–$1,2590%20%10th90th$676$1.0$5.0$20.0$100.0$500.0$2.0K

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
$0.63 / $1,122.02 / $4,897.79
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$467.74 / $660.69 / $1,288.25
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$724.44 / $724.44 / $724.44
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$147.91 / $724.44 / $724.44
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$467.74 / $724.44 / $1,174.90
Health Alliance Plan
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$0.63 / $2,290.87 / $4,897.79
Health Alliance Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$524.81 / $870.96 / $1,412.54
Priority Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$436.52 / $676.08 / $1,071.52
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$186.21 / $758.58 / $1,698.24
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$537.03 / $776.25 / $1,047.13