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Nebraska rates for HCPCS 21085

Impression and custom preparation; oral surgical splint

Facilitymedian $3,236 · 10th–90th $447–$11,4820%10%20%10th90th$3,236Professionalmedian $912 · 10th–90th $479–$2,0420%10%10th90th$912$200.0$500.0$1.0K$2.0K$5.0K$10.0K$20.0K

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
$870.96 / $7,943.28 / $14,454.40
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$478.63 / $870.96 / $2,630.27
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$3,235.94 / $4,265.80 / $8,317.64
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$467.74 / $851.14 / $1,288.25
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$194.98 / $194.98 / $194.98
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$794.33 / $1,318.26 / $2,041.74
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$446.68 / $851.14 / $1,862.09
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$794.33 / $1,348.96 / $5,128.61
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,071.52 / $1,513.56 / $2,089.30
Midlands
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$194.98 / $194.98 / $194.98
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$954.99 / $1,513.56 / $2,089.30
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$295.12 / $1,047.13 / $3,801.89
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$616.60 / $1,023.29 / $1,659.59