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South Carolina rates for HCPCS 21085

Impression and custom preparation; oral surgical splint

Facilitymedian $1,995 · 10th–90th $589–$9,1200%10%10th90th$1,995Professionalmedian $676 · 10th–90th $479–$1,3180%10%10th90th$676$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
$776.25 / $6,309.57 / $16,595.87
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$478.63 / $676.08 / $1,318.26
Ambetter
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$691.83 / $691.83 / $691.83
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,698.24 / $3,890.45 / $7,079.46
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$436.52 / $758.58 / $1,258.93
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$891.25 / $891.25 / $891.25
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$588.84 / $870.96 / $1,318.26
Medcost
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$575.44 / $851.14 / $1,412.54
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $33.11 / $33.11
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$190.55 / $1,122.02 / $4,677.35
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$457.09 / $676.08 / $1,122.02