Custom oral surgery splint at St Luke's Methodist Hospital

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

PR PREP FACE/ORAL PROST ORAL SPLINT

Cedar Rapids, IA

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Pricing by billing methodology

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How this price compares nationally

St Luke's Methodist Hospital’s median price of $469 is about the same as the median hospital's median price ($472), higher than 49% of the 1,478 hospitals reporting CPT 21085. The highlighted bar is where this hospital falls; shaded is the middle 50% of hospitals.

Payers reporting CPT 21085 at St Luke's Methodist Hospital

Negotiated rates from the hospital’s own file: 6 payers, 22 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	Aetna medicare advantage case rate · outpatient	$220	$220	—	—	—	$220 – $220
2	Molina medicare advantage case rate · outpatient	$220	$220	—	—	—	$220 – $220
3	Wellmark medicare advantage case rate · outpatient	$220	$220	—	—	—	$220 – $220
4	Humana medicare advantage case rate · outpatient	$226	$226	—	—	—	$226 – $226
5	UnitedHealthcare medicare advantage case rate · outpatient	$226	$226	—	—	—	$226 – $226
6	Aetna medicare advantage fee schedule · both	$447	$447	—	—	—	$447 – $447
7	Aetna hmo fee schedule · outpatient	$453	$453	—	—	—	$453 – $453
8	Molina medicare advantage fee schedule · both	$456	$456	—	—	—	$456 – $456
9	Wellmark medicare advantage fee schedule · both	$456	$456	—	—	—	$456 – $456
10	Humana medicare advantage fee schedule · both	$469	$469	—	—	—	$469 – $469
11	UnitedHealthcare medicare advantage fee schedule · both	$469	$469	—	—	—	$469 – $469
12	Aetna ppo fee schedule · outpatient	$471	$471	—	—	—	$471 – $471
13	UnitedHealthcare hmo fee schedule · outpatient	$578	$578	—	—	—	$578 – $578
14	UnitedHealthcare ppo fee schedule · outpatient	$578	$578	—	—	—	$578 – $578
15	Wellmark commercial fee schedule · both	$944	$944	—	—	—	$944 – $944
16	Wellmark hmo fee schedule · both	$944	$944	—	—	—	$944 – $944
17	Wellmark ppo fee schedule · both	$1.1k	$1.1k	—	—	—	$1.1k – $1.1k
18	Cigna commercial fee schedule · both	$1.2k	$1.2k	—	—	—	$1.2k – $1.2k
19	Aetna hmo fee schedule · both	$1.3k	$1.3k	—	—	—	$1.3k – $1.3k
20	Aetna ppo fee schedule · both	$1.6k	$1.6k	—	—	—	$1.6k – $1.6k
21	UnitedHealthcare hmo fee schedule · both	$1.6k	$1.6k	—	—	—	$1.6k – $1.6k
22	UnitedHealthcare ppo fee schedule · both	$1.6k	$1.6k	—	—	—	$1.6k – $1.6k

Last updated: Jan 28, 2026

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