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Montana rates for HCPCS 21085

Impression and custom preparation; oral surgical splint

Facilitymedian $1,023 · 10th–90th $813–$1,3180%20%10th90th$1,023Professionalmedian $851 · 10th–90th $501–$1,7380%10%10th90th$851$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
Professional
Modifier
Typical Low / Median / Typical High
$489.78 / $794.33 / $2,344.23
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$758.58 / $758.58 / $1,071.52
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$758.58 / $758.58 / $758.58
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$645.65 / $794.33 / $1,071.52
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$831.76 / $1,071.52 / $1,318.26
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$831.76 / $1,071.52 / $1,318.26
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$588.84 / $933.25 / $1,412.54
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$79.43 / $891.25 / $1,348.96
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$912.01 / $912.01 / $912.01
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$676.08 / $1,000.00 / $1,318.26