Custom oral surgery splint at Ascension Seton

Hospitals report these codes with terse, inconsistent chargemaster text. This plain-English title was written by an AI model from that text and has not been reviewed by a person, so it can be wrong. The prices on this page come straight from hospital filings and do not depend on it.

Model: claude-haiku-5-5
Provider: anthropic
API: message_batches
Reasoning effort: low
Max output tokens: 4096
Prompt version (hash): 444523875572
Generated: October 20, 2026

Original text from hospital filings

IMPRES&PREP ORAL SURG SPLINT

Austin, TX

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Pricing by billing methodology

Price type

How this price compares nationally

Ascension Seton’s median price of $224 is 53% below the median hospital's median price ($472), higher than 6% of the 1,469 hospitals reporting CPT 21085. The highlighted bar is where this hospital falls; shaded is the middle 50% of hospitals.

Payers reporting CPT 21085 at Ascension Seton

Negotiated rates from the hospital’s own file: 9 payers, 39 plan rates. A facility fee, a professional fee, a per diem and a case rate are different bills, so each is listed on its own. Open a payer to see it across hospitals.

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1	Blue Cross Blue Shield 4127_blue cross blue shield bav exchange 20250101 fee schedule · outpatient	$74	$74	—	—	—	$74 – $74
2	Blue Cross Blue Shield 4166_blue cross chip (aus) outpatient 20241201 fee schedule · outpatient	$88	$88	—	—	—	$88 – $88
3	Blue Cross Blue Shield 4166_blue cross chip/star kids (aus) outpatient 20241201 fee schedule · outpatient	$88	$88	—	—	—	$88 – $88
4	Blue Cross Blue Shield 4168_blue cross chip (chi,dcn) outpatient 20241201 fee schedule · outpatient	$88	$88	—	—	—	$88 – $88
5	Blue Cross Blue Shield 4168_blue cross chip/star kids (chi,dcn) outpatient 20241201 fee schedule · outpatient	$88	$88	—	—	—	$88 – $88
6	Blue Cross Blue Shield 4219_chirp blue cross star (chi,dcn) outpatient 20241201 fee schedule · outpatient	$88	$88	—	—	—	$88 – $88
7	Blue Cross Blue Shield 4999_blue cross star kids (aus) outpatient 20241201 fee schedule · outpatient	$88	$88	—	—	—	$88 – $88
8	Blue Cross Blue Shield 5003_blue cross star kids (chi,dcn) outpatient 20241201 fee schedule · outpatient	$88	$88	—	—	—	$88 – $88
9	UnitedHealthcare 4253_chirp uhc star (chi,dcn) outpatient 20241201 fee schedule · outpatient	$88	$88	—	—	—	$88 – $88
10	UnitedHealthcare 4264_chirp uhc star plus (chi,dcn) outpatient 20241201 fee schedule · outpatient	$88	$88	—	—	—	$88 – $88
11	UnitedHealthcare 4311_uhc star kids (chi,dcn) outpatient 20241201 fee schedule · outpatient	$88	$88	—	—	—	$88 – $88
12	Blue Cross Blue Shield 4440_blue cross blue shield hpn 20250501 fee schedule · outpatient	$99	$99	—	—	—	$99 – $99
13	Blue Cross Blue Shield 4497_blue cross blue shield hpn (dell, williamson,hays) 20250501 fee schedule · outpatient	$99	$99	—	—	—	$99 – $99
14	Blue Cross Blue Shield 4095_blue cross blue shield hmo essentials 20250101 fee schedule · outpatient	$106	$106	—	—	—	$106 – $106
15	Blue Cross Blue Shield 4094_blue cross blue shield ppo 20250101 fee schedule · outpatient	$120	$120	—	—	—	$120 – $120
16	Blue Cross Blue Shield 3691_chirp blue cross star (aus) inpatient 20240901 fee schedule · both	$169	$169	—	—	—	$169 – $169
17	Blue Cross Blue Shield 4217_chirp blue cross star (aus) outpatient 20241201 fee schedule · both	$169	$169	—	—	—	$169 – $169
18	UnitedHealthcare 3735_chirp uhc star (aus) inpatient 20240901 fee schedule · both	$169	$169	—	—	—	$169 – $169
19	UnitedHealthcare 3746_chirp uhc star plus (aus) inpatient 20240901 fee schedule · both	$169	$169	—	—	—	$169 – $169
20	UnitedHealthcare 4251_chirp uhc star (aus) outpatient 20241201 fee schedule · both	$169	$169	—	—	—	$169 – $169
21	UnitedHealthcare 4262_chirp uhc star plus (aus) outpatient 20241201 fee schedule · both	$169	$169	—	—	—	$169 – $169
22	UnitedHealthcare 4309_uhc star kids (aus) outpatient 20241201 fee schedule · both	$169	$169	—	—	—	$169 – $169
23	UnitedHealthcare 4320_uhc star kids (aus) inpatient 20240901 fee schedule · both	$169	$169	—	—	—	$169 – $169
24	Aetna 4659_medicare advantage aetna inpatient 20251001 other · inpatient	$225	$225	—	—	—	$225 – $225
25	Aetna 4749_medicare advantage aetna outpatient 20250811 other · outpatient	$225	$225	—	—	—	$225 – $225

Page 1 of 2 · 39 rates

Last updated: Jan 1, 2026

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