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Washington rates for HCPCS 21085

Impression and custom preparation; oral surgical splint

Facilitymedian $1,122 · 10th–90th $550$5,1290%5%10%10th90th$1,122Professionalmedian $871 · 10th–90th $490$1,6980%5%10%10th90th$871$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
$912.01 / $1,548.82 / $18,620.87
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$489.78 / $758.58 / $1,819.70
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$501.19 / $676.08 / $1,348.96
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$691.83 / $1,096.48 / $1,621.81
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$295.12 / $707.95 / $870.96
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$616.60 / $1,023.29 / $1,819.70
Kaiser Permanente
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$338.84 / $1,000.00 / $1,659.59
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$446.68 / $1,023.29 / $1,659.59
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $33.11 / $257.04
Pacific Source
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$851.14 / $1,348.96 / $1,479.11
Premera BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$239.88 / $891.25 / $933.25
Premera BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$660.69 / $1,023.29 / $1,659.59
Regence BlueShield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$501.19 / $691.83 / $1,318.26
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$691.83 / $1,096.48 / $1,621.81
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$218.78 / $812.83 / $1,905.46
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$645.65 / $954.99 / $1,584.89
Wellpoint
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$457.09 / $812.83 / $1,023.29