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Oklahoma rates for HCPCS 21085

Impression and custom preparation; oral surgical splint

Facilitymedian $6,457 · 10th–90th $575–$13,8040%10%10th90th$6,457Professionalmedian $631 · 10th–90th $447–$9770%10%10th90th$631$100.0$500.0$2.0K$10.0K$50.0K

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
$707.95 / $2,089.30 / $6,606.93
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$446.68 / $616.60 / $954.99
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$6,165.95 / $9,772.37 / $15,848.93
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$588.84 / $645.65 / $891.25
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$199.53 / $199.53 / $199.53
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$562.34 / $891.25 / $1,122.02
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$457.09 / $741.31 / $1,862.09
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$602.56 / $812.83 / $5,128.61
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$138.04 / $575.44 / $1,548.82
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$446.68 / $630.96 / $870.96