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Oregon rates for HCPCS 21085

Impression and custom preparation; oral surgical splint

Facilitymedian $1,259 · 10th–90th $692$1,7380%20%10th90th$1,259Professionalmedian $955 · 10th–90th $501$1,6980%10%20%10th90th$955$10.0$100.0$1.0K$10.0K$100.0K$1.0M

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
$977.24 / $1,258.93 / $7,943.28
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$478.63 / $691.83 / $1,548.82
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$851.14 / $851.14 / $851.14
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$707.95 / $1,148.15 / $1,778.28
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$812.83 / $1,202.26 / $1,737.80
Moda Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$645.65 / $977.24 / $1,584.89
Moda Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$776.25 / $1,202.26 / $1,698.24
Pacific Source
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$812.83 / $1,348.96 / $1,479.11
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$645.65 / $977.24 / $1,584.89
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$79.43 / $1,174.90 / $1,737.80
Regence BlueShield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$562.34 / $812.83 / $1,445.44
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$912.01 / $1,318.26 / $1,862.09
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$676.08 / $1,071.52 / $5,128.61
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$724.44 / $1,174.90 / $1,737.80