Oral device/appliance prefab

Payers reporting HCPCS E0485

Payer pricing summary

Low

Average

$463

Median

$342

High

$2.2k

Payer rate distribution

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#
1	Blue Cross Blue Shield facility · fee schedule · outpatient · +11 other terms	33	$324	$479	$324	68%	—	$126 – $1.4k
2	Aetna fee schedule · outpatient · +10 other terms	19	$330	$520	$506	97%	—	$44 – $2.1k
3	Anthem facility · case rate · outpatient · +7 other terms	15	$767	$838	$197	23%	—	$522 – $1.3k
4	Caresource facility · case rate · outpatient · +3 other terms	15	$781	$839	$192	23%	—	$522 – $1.3k
5	Molina facility · case rate · outpatient · +2 other terms	15	$767	$840	$195	23%	—	$537 – $1.3k
6	UnitedHealthcare facility · case rate · outpatient · +9 other terms	15	$781	$849	$199	23%	—	$537 – $1.3k
7	Wellmark fee schedule · both · +1 other terms	13	$304	$318	$260	82%	—	$55 – $850
8	Bcbs Mn fee schedule · outpatient · +3 other terms	12	$1.0k	$768	$444	58%	—	$291 – $1.3k
9	Optum facility · case rate · outpatient · +1 other terms	11	$723	$794	$177	22%	—	$652 – $1.2k
10	Cigna professional · fee schedule · outpatient · +9 other terms	10	$176	$229	$81	35%	—	$176 – $385
11	Highmark fee schedule · outpatient · +1 other terms	10	$440	$440	—	—	—	$440 – $440
12	Aetna Better Health fee schedule · inpatient · +1 other terms	7	$340	$340	—	—	—	$340 – $340
13	Ambetter percent of total billed charges · bothfrom % of charges	5	$124	$131	$18	14%	—	$124 – $189
14	Humana fee schedule · inpatient · +6 other terms	5	$330	$330	—	—	—	$330 – $330
15	Oscar percent of total billed charges · bothfrom % of charges	4	$143	$143	—	—	—	$143 – $143
16	Phcs percent of total billed charges · bothfrom % of charges	4	$210	$210	—	—	—	$210 – $210
17	Bcbs Ks fee schedule · outpatient · +1 other terms	3	$1.3k	$1.4k	$80	6%	—	$1.3k – $1.5k
18	First Health professional · fee schedule · both · +1 other terms	3	$214	$214	$149	70%	—	$36 – $363
19	Devoted facility · percent of total billed charges · inpatientfrom % of charges	2	$305	$305	$128	42%	—	$176 – $433
20	MultiPlan percent of total billed charges · bothfrom % of charges · +4 other terms	2	$400	$349	$156	45%	—	$222 – $634
21	Regence percent of total billed charges · bothfrom % of charges	2	$394	$394	$148	37%	—	$100 – $490
22	Bcbs Id professional · fee schedule · outpatient · +1 other terms	1	$1	$1	—	—	—	$1 – $1
23	Bcbs Il professional · fee schedule · both	1	$2.2k	$2.2k	—	—	—	$2.2k – $2.2k
24	Bcbs La facility · fee schedule · outpatient	1	$0	$0	—	—	—	$0 – $0
25	Bcbs Nc facility · fee schedule · outpatient	1	$176	$176	—	—	—	$176 – $176

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