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West Virginia rates for HCPCS 21085

Impression and custom preparation; oral surgical splint

Facilitymedian $646 · 10th–90th $479–$1,4130%20%10th90th$646Professionalmedian $631 · 10th–90th $447–$1,0960%20%10th90th$631$50.0$100.0$200.0$500.0$1.0K$2.0K

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 / $645.65 / $1,412.54
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$446.68 / $630.96 / $1,071.52
CareSource
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$524.81 / $524.81 / $630.96
CareSource
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$562.34 / $562.34 / $562.34
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$34.67 / $831.76 / $831.76
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$478.63 / $870.96 / $3,715.35
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$457.09 / $457.09 / $660.69
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$457.09 / $724.44 / $1,071.52