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New Mexico rates for HCPCS 21085

Impression and custom preparation; oral surgical splint

Facilitymedian $1,096 · 10th–90th $631–$7,7620%10%20%10th90th$1,096Professionalmedian $676 · 10th–90th $457–$1,2020%20%10th90th$676$50.0$200.0$1.0K$5.0K$20.0K$100.0K

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
$630.96 / $1,096.48 / $3,467.37
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$457.09 / $660.69 / $1,174.90
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,511.89 / $6,165.95 / $10,000.00
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$588.84 / $812.83 / $1,071.52
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$537.03 / $912.01 / $1,949.84
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $33.11 / $575.44
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$537.03 / $831.76 / $1,202.26
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$549.54 / $933.25 / $1,380.38
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$229.09 / $1,096.48 / $1,412.54
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$616.60 / $891.25 / $1,380.38