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Missouri rates for HCPCS 21085

Impression and custom preparation; oral surgical splint

Facilitymedian $3,467 · 10th–90th $537–$7,7620%5%10%10th90th$3,467Professionalmedian $692 · 10th–90th $468–$1,7380%10%10th90th$692$100.0$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
$501.19 / $3,890.45 / $8,511.38
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$446.68 / $676.08 / $1,778.28
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,238.72 / $4,677.35 / $8,912.51
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$562.34 / $707.95 / $1,096.48
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$446.68 / $724.44 / $1,023.29
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$562.34 / $851.14 / $1,412.54
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$407.38 / $758.58 / $1,445.44
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$691.83 / $1,096.48 / $5,128.61
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$190.55 / $602.56 / $1,412.54
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$501.19 / $741.31 / $1,122.02