go back

Virginia rates for HCPCS 21085

Impression and custom preparation; oral surgical splint

Facilitymedian $851 · 10th–90th $490$7,0790%5%10%10th90th$851Professionalmedian $708 · 10th–90th $479$1,2880%10%10th90th$708$100.0$200.0$500.0$1.0K$2.0K$5.0K$10.0K

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
$489.78 / $3,235.94 / $8,912.51
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$489.78 / $691.83 / $1,445.44
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,137.96 / $2,570.40 / $2,951.21
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$467.74 / $691.83 / $1,174.90
CareFirst
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$478.63 / $691.83 / $1,047.13
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$645.65 / $645.65 / $645.65
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$524.81 / $812.83 / $1,380.38
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$691.83 / $870.96 / $1,047.13
Medcost
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$933.25 / $1,174.90 / $1,548.82
Medcost
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$524.81 / $812.83 / $1,258.93
Medcost
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$891.25 / $891.25 / $891.25
Sentara
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$478.63 / $741.31 / $1,479.11
Sentara
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$660.69 / $933.25 / $1,819.70
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$204.17 / $1,047.13 / $2,344.23
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$446.68 / $758.58 / $1,230.27