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Custom Oral Surgical Splint Fitting

Wisconsin rates for HCPCS 21085

Custom fitting and creation of a removable splint worn in the mouth after oral or jaw surgery. It is used to protect the surgical site, hold dressings or grafts in place, or support the surrounding tissue while it heals.

Rates data updated July 2026.

Facilitymedian $2,754 · 10th–90th $759$5,2480%10%10th90th$2,754Professionalmedian $1,072 · 10th–90th $479$3,0200%5%10%10th90th$1,072$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
Setting
Facility
Modifier
Global
Typical Low
$478.63
Median
$1,023.29
Typical High
$14,454.40
Aetna
Setting
Professional
Modifier
Global
Typical Low
$478.63
Median
$691.83
Typical High
$2,691.53
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$2,187.76
Median
$3,090.30
Typical High
$5,754.40
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$660.69
Median
$1,000.00
Typical High
$2,570.40
Cigna
Setting
Facility
Modifier
Global
Typical Low
$1,819.70
Median
$2,137.96
Typical High
$3,388.44
Cigna
Setting
Professional
Modifier
Global
Typical Low
$676.08
Median
$1,737.80
Typical High
$3,090.30
DeanCare
Setting
Facility
Modifier
Global
Typical Low
$537.03
Median
$977.24
Typical High
$3,162.28
DeanCare
Setting
Professional
Modifier
Global
Typical Low
$912.01
Median
$1,318.26
Typical High
$2,041.74
Medica
Setting
Facility
Modifier
Global
Typical Low
$562.34
Median
$977.24
Typical High
$1,778.28
Medica
Setting
Professional
Modifier
Global
Typical Low
$758.58
Median
$1,479.11
Typical High
$5,128.61
Molina
Setting
Professional
Modifier
Global
Typical Low
$32.36
Median
$33.11
Typical High
$794.33
Network Health
Setting
Facility
Modifier
Global
Typical Low
$831.76
Median
$933.25
Typical High
$2,344.23
Network Health
Setting
Professional
Modifier
Global
Typical Low
$851.14
Median
$1,778.28
Typical High
$2,398.83
Prevea360
Setting
Facility
Modifier
Global
Typical Low
$478.63
Median
$776.25
Typical High
$1,445.44
Quartz
Setting
Professional
Modifier
Global
Typical Low
$831.76
Median
$1,412.54
Typical High
$2,344.23
Quartz
Setting
Facility
Modifier
Global
Typical Low
$257.04
Median
$1,122.02
Typical High
$3,019.95
Quartz
Setting
Professional
Modifier
Global
Typical Low
$794.33
Median
$3,388.44
Typical High
$5,011.87
Security Health
Setting
Professional
Modifier
Global
Typical Low
$1,584.89
Median
$1,584.89
Typical High
$2,238.72
Security Health
Setting
Professional
Modifier
Global
Typical Low
$2,187.76
Median
$3,090.30
Typical High
$4,365.16
United
Setting
Facility
Modifier
Global
Typical Low
$954.99
Median
$1,513.56
Typical High
$1,949.84
United
Setting
Professional
Modifier
Global
Typical Low
$602.56
Median
$1,000.00
Typical High
$2,630.27