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Texas rates for HCPCS 21085

Impression and custom preparation; oral surgical splint

Facilitymedian $1,000 · 10th–90th $151$6,7610%5%10%10th90th$1,000Professionalmedian $692 · 10th–90th $468$1,1480%20%10th90th$692$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
$870.96 / $3,715.35 / $12,882.50
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$467.74 / $691.83 / $1,071.52
Ambetter
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$645.65 / $691.83 / $691.83
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$102.33 / $208.93 / $954.99
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$446.68 / $630.96 / $1,047.13
Christus
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$426.58 / $630.96 / $630.96
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$831.76 / $831.76 / $831.76
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$524.81 / $870.96 / $1,380.38
Lucent Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$54.95 / $56.23 / $3,019.95
Lucent Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$5,011.87 / $5,754.40 / $5,754.40
Moda Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$512.86 / $851.14 / $1,995.26
Moda Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$489.78 / $741.31 / $1,288.25
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $389.05 / $588.84
Oscar Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$794.33 / $794.33 / $794.33
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$501.19 / $812.83 / $1,380.38
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$524.81 / $851.14 / $1,348.96
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$173.78 / $870.96 / $2,238.72
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$478.63 / $691.83 / $1,047.13
Wellpoint
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$691.83 / $707.95 / $724.44