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Pennsylvania rates for HCPCS 21085

Impression and custom preparation; oral surgical splint

Facilitymedian $3,981 · 10th–90th $692$8,3180%10%10th90th$3,981Professionalmedian $661 · 10th–90th $468$1,2590%10%10th90th$661$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
$724.44 / $4,265.80 / $8,511.38
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$467.74 / $660.69 / $1,230.27
Capital Blue Cross
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$3,801.89 / $4,466.84 / $57,543.99
Capital Blue Cross
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$691.83 / $741.31 / $870.96
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$512.86 / $776.25 / $1,348.96
Emblem Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$851.14 / $1,148.15 / $1,445.44
Geisinger
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$676.08 / $891.25 / $1,380.38
Martin's Point
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$691.83 / $3,801.89 / $8,317.64
Martin's Point
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$467.74 / $660.69 / $1,412.54
Oscar Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$794.33 / $1,148.15 / $1,737.80
UPMC Health Plan
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$478.63 / $524.81 / $831.76
UPMC Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$407.38 / $524.81 / $691.83
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$354.81 / $630.96 / $3,890.45
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$478.63 / $707.95 / $1,230.27