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South Dakota rates for HCPCS 21085

Impression and custom preparation; oral surgical splint

Facilitymedian $1,072 · 10th–90th $479–$6,0260%10%10th90th$1,072Professionalmedian $794 · 10th–90th $479–$1,6220%10%10th90th$794$500.0$1.0K$2.0K$5.0K

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
$478.63 / $2,041.74 / $6,025.60
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$436.52 / $691.83 / $1,380.38
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,000.00 / $1,412.54 / $2,041.74
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$691.83 / $977.24 / $1,584.89
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$645.65 / $1,621.81 / $5,128.61
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,071.52 / $1,258.93 / $1,659.59
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,071.52 / $1,258.93 / $1,698.24
Sanford Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$794.33 / $1,071.52 / $1,348.96
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$812.83 / $812.83 / $812.83
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$602.56 / $1,047.13 / $1,905.46
Wellmark
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$933.25 / $1,148.15 / $1,621.81