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Ohio rates for HCPCS 21085

Impression and custom preparation; oral surgical splint

Facilitymedian $1,778 · 10th–90th $603$10,7150%10%10th90th$1,778Professionalmedian $661 · 10th–90th $468$1,1220%20%10th90th$661$10.0$50.0$200.0$1.0K$5.0K$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
$616.60 / $2,344.23 / $11,481.54
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$467.74 / $660.69 / $1,148.15
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$707.95 / $2,238.72 / $3,981.07
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$467.74 / $630.96 / $1,023.29
CareSource
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$467.74 / $467.74 / $549.54
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$645.65 / $794.33 / $21,379.62
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$512.86 / $831.76 / $1,288.25
Medical Mutual of Ohio
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$21,379.62 / $21,379.62 / $21,379.62
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$512.86 / $812.83 / $1,258.93
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $33.11 / $354.81
SummaCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$100.00 / $100.00 / $288.40
SummaCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$446.68 / $707.95 / $1,230.27
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$177.83 / $851.14 / $2,951.21
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$436.52 / $691.83 / $1,122.02