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North Carolina rates for HCPCS 21085

Impression and custom preparation; oral surgical splint

Facilitymedian $891 · 10th–90th $479–$2,8180%10%20%10th90th$891Professionalmedian $741 · 10th–90th $479–$1,8200%20%10th90th$741$1.0$5.0$20.0$100.0$500.0$2.0K$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
$0.58 / $1,174.90 / $6,918.31
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$478.63 / $691.83 / $1,659.59
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$616.60 / $912.01 / $1,995.26
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$223.87 / $223.87 / $602.56
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$602.56 / $891.25 / $1,548.82
Medcost
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,174.90 / $1,174.90 / $1,548.82
Medcost
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$501.19 / $794.33 / $1,348.96
Oscar Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,071.52 / $1,288.25 / $1,513.56
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$186.21 / $724.44 / $1,949.84
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$489.78 / $741.31 / $1,348.96
Wellcare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$56.23 / $3,019.95 / $3,019.95
Wellcare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$5,011.87 / $5,011.87 / $5,754.40