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Wisconsin rates for HCPCS 21085

Impression and custom preparation; oral surgical splint

Facilitymedian $2,818 · 10th–90th $871$5,4950%10%10th90th$2,818Professionalmedian $851 · 10th–90th $479$2,4550%10%10th90th$851$50.0$200.0$1.0K$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 / $1,023.29 / $2,570.40
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$467.74 / $660.69 / $1,737.80
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,238.72 / $3,090.30 / $5,754.40
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$660.69 / $1,000.00 / $2,570.40
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,819.70 / $2,089.30 / $3,388.44
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$691.83 / $1,698.24 / $3,162.28
DeanCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$537.03 / $977.24 / $3,162.28
DeanCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$912.01 / $1,318.26 / $2,041.74
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$562.34 / $977.24 / $1,778.28
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$758.58 / $1,479.11 / $5,128.61
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $33.11 / $794.33
Network Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$831.76 / $933.25 / $2,344.23
Network Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$851.14 / $1,778.28 / $2,398.83
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$831.76 / $1,412.54 / $2,344.23
Quartz
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$257.04 / $1,258.93 / $3,019.95
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$870.96 / $3,388.44 / $5,011.87
Security Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,584.89 / $1,584.89 / $2,238.72
Security Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,187.76 / $3,090.30 / $4,365.16
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,000.00 / $1,584.89 / $2,630.27
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$602.56 / $1,000.00 / $2,511.89