Impression & Preparation Oral Surgical Splint (CPT 21085)
21085 is the billing code hospitals use for this service. Prices below are each hospital's own posted facility charge.
Name shown as it appears in hospital billing files.
121 of 2639 hospitals post a price for this code. Hospitals that don't post one are left out. We never guess a number.
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| Hospital | Location | Cash price | Gross charge | Medicare pays | × Medicare |
|---|---|---|---|---|---|
| Washington County Hospital and Nursing Home | Chatom, AL | $54.17 | — | $204.13 | 0.3× |
| Madison Memorial Hospital | Rexburg, ID | $63.75 | $85 | $233.99 | 0.3× |
| Essentia Health-St. Mary's Medical Center | Duluth, MN | $188.10 | $285 | $245.22 | 0.8× |
| Essentia Health-Duluth | Duluth, MN | $188.10 | $285 | $244.45 | 0.8× |
| University Hospital – UMMC | Jackson, MS | $204 | $510 | $213.84 | 1.0× |
| UMMC Madison | Canton, MS | $204 | $510 | $213.84 | 1.0× |
| Children's Hospital of The King's Daughters | Norfolk, VA | $204.07 | $226.74 | $231.09 | 0.9× |
| Lakeside Medical Center | Belle Glade, FL | $233.10 | — | $247.34 | 0.9× |
| Dallas Medical Center | Dallas, TX | $236 | $1,058 | $237.93 | 1.0× |
| Our Lady of the Lake Surgical Hospital | Slidell, LA | $254.99 | — | $215.09 | 1.2× |
| Dartmouth Hitchcock Medical Center | Lebanon, NH | $269.28 | $880 | $252.90 | 1.1× |
| Griffin Hospital | Derby, CT | $277.61 | — | $283.94 | 1.0× |
| Summit Medical Center, LLC | Edmond, OK | $282.74 | — | $227.80 | 1.2× |
| Valleywise Health Medical Center | Phoenix, AZ | $290.65 | — | $252.74 | 1.1× |
| Saint Thomas Hospital for Specialty Surgery | Nashville, TN | $296.14 | — | $227.23 | 1.3× |
| Legent Orthopedic Hospital | Carrollton, TX | $297.90 | $6,763.20 | $238.32 | 1.3× |
| Wetzel County Hospital | New Martinsville, WV | $298 | $596 | $227.20 | 1.3× |
| Touro | New Orleans, LA | $312.76 | $2,234 | $222.32 | 1.4× |
| United Hospital Center | Bridgeport, WV | $326 | $652 | $229.10 | 1.4× |
| Camden Clark Medical Center | Parkersburg, WV | $326 | $652 | $227.20 | 1.4× |
| Unity Health - White County Medical Center | Searcy, AR | $371 | $1,484 | $215.66 | 1.7× |
| Unity Health - Jacksonville | Jacksonville, AR | $371 | $1,484 | $222.54 | 1.7× |
| Unity Health - Newport | Newport, AR | $371 | $1,484 | $215.66 | 1.7× |
| West Jefferson Medical Center | Marrero, LA | $375.68 | $2,348 | $222.32 | 1.7× |
| Nacogdoches Memorial Hospital | Nacogdoches, TX | $382 | $1,272 | $237.93 | 1.6× |
| Reynolds Memorial Hospital | Glen Dale, WV | $394.50 | $789 | $227.20 | 1.7× |
| J.W. Ruby Memorial Hospital | Morgantown, WV | $404 | $808 | $229.10 | 1.8× |
| Duke University Hospital | Durham, NC | $429.57 | $1,591 | $235.68 | 1.8× |
| Ochsner Rush Medical Center | Meridian, MS | $468.30 | $1,338 | $209.15 | 2.2× |
| Duncan Regional Hospital, Inc | Duncan, OK | $473.44 | — | $227.80 | 2.1× |
| Vandalia Health Mon Medical Center | Morgantown, WV | $510.30 | $1,020.59 | $229.10 | 2.2× |
| Vandalia Health Mon Marion Neighborhood Hospital | White Hall, WV | $510.30 | $1,020.59 | $227.20 | 2.2× |
| Yale New Haven Hospital | New Haven, CT | $510.76 | $865.69 | $283.94 | 1.8× |
| St. Clare Hospital | Lakewood, WA | $531.52 | $1,844 | $276.42 | 1.9× |
| University Medical Center New Orleans | New Orleans, LA | $545.82 | $2,481 | $214.47 | 2.5× |
| Manning Family Children's | New Orleans, LA | $557.01 | $2,063 | $222.32 | 2.5× |
| Memorial Medical Center | Port Lavaca, TX | $558.96 | $798.52 | $237.93 | 2.3× |
| St. Anthony Hospital | Gig Harbor, WA | $560.86 | $1,844 | $276.42 | 2.0× |
| St. Anne Hospital | Burien, WA | $563.08 | $1,844 | $275.04 | 2.0× |
| Concord Hospital | Concord, NH | $566.10 | $1,887 | $252.90 | 2.2× |
| Concord Hospital – Laconia | Laconia, NH | $566.10 | $1,887 | $252.90 | 2.2× |
| Concord Hospital – Franklin | Franklin, NH | $566.10 | $1,887 | $252.90 | 2.2× |
| Children's Hospital Colorado | Aurora, CO | $566.15 | $871 | $249.85 | 2.3× |
| East Carroll Parish Hospital | Lake Providence, LA | $576 | $768 | $215.64 | 2.7× |
| St. Francis Hospital | Federal Way, WA | $578.69 | $1,844 | $275.04 | 2.1× |
| Boston Medical Center | Boston, MA | $601.20 | $1,336 | $283.85 | 2.1× |
| St. Joseph Medical Center | Tacoma, WA | $610.73 | $1,844 | $276.42 | 2.2× |
| Valley View Hospital | Glenwood Springs, CO | $616.25 | $725 | $249.85 | 2.5× |
| St. Elizabeth Hospital | Enumclaw, WA | $651.61 | $1,844 | $275.04 | 2.4× |
| Northwest Surgical Hospital | Oklahoma City, OK | $683.40 | — | $227.80 | 3.0× |
| Community Hospital, LLC | Oklahoma City, OK | $683.40 | — | $227.80 | 3.0× |
| Boca Raton Regional Hospital | Boca Raton, FL | $685.10 | $1,054 | $247.34 | 2.8× |
| Baptist Hospital of Miami | Miami, FL | $704.60 | $1,084 | $247.34 | 2.8× |
| St. Michael Medical Center | Silverdale, WA | $813.85 | $1,844 | $272.75 | 3.0× |
| Ochsner Laird Hospital | Union, MS | $816.18 | $1,338 | $204.20 | 4.0× |
| University Medical Center | Las Vegas, NV | $822.30 | $2,741 | $258.89 | 3.2× |
| Ochsner Scott Regional | Morton, MS | $842.94 | $1,338 | $213.84 | 3.9× |
| Vanderbilt Bedford Hospital | Shelbyville, TN | $885.08 | $3,052 | $226.17 | 3.9× |
| Vanderbilt Tullahoma-Harton Hospital | Tullahoma, TN | $885.08 | $3,052 | $224.85 | 3.9× |
| Vanderbilt Wilson County Hospital | Lebanon, TN | $885.08 | $3,052 | $227.23 | 3.9× |
| Ochsner Watkins Hospital | Quitman, MS | $896.46 | $1,338 | $204.20 | 4.4× |
| Ochsner Stennis Hospital | De Kalb, MS | $923.22 | $1,338 | $204.20 | 4.5× |
| Hennepin County Medical Center | Minneapolis, MN | $947.70 | $2,106 | $248.06 | 3.8× |
| Spanish Peaks Regional Health Center | Walsenburg, CO | $997.20 | $1,108 | $249.85 | 4.0× |
| Ochsner Choctaw General | Butler, AL | $1,016.88 | $1,338 | $204.13 | 5.0× |
| Harborview Medical Center | Seattle, WA | $1,019.66 | $1,456.66 | $274.27 | 3.7× |
| UF Health Jacksonville | Jacksonville, FL | $1,050.11 | $1,909.29 | $247.34 | 4.2× |
| Southwest Medical Center | Liberal, KS | $1,061.20 | $1,326.50 | $217.82 | 4.9× |
| University Medical Center | Lubbock, TX | $1,067 | $1,067 | $237.93 | 4.5× |
| Baylor Scott and White Medical Center Uptown | Dallas, TX | $1,071 | $1,785 | $237.93 | 4.5× |
| Harris Health | Houston, TX | $1,119.09 | $2,008 | $237.93 | 4.7× |
| Nebraska Medical Center | Omaha, NE | $1,202.57 | $1,850.10 | $245.94 | 4.9× |
| Bellevue Medical Center | Bellevue, NE | $1,202.57 | $1,850.10 | $245.94 | 4.9× |
| DeSoto Regional Health System | Mansfield, LA | $1,225 | $1,750 | $214.47 | 5.7× |
| Granville Medical Center | Oxford, NC | $1,271.20 | $1,589 | $235.81 | 5.4× |
| Connecticut Children's Medical Center | Hartford, CT | $1,279.20 | $2,132 | $283.94 | 4.5× |
| PeaceHealth St. Joseph Medical Center | Bellingham, WA | $1,370.20 | $2,108 | $263.93 | 5.2× |
| Lallie Kemp Regional Medical Center | Independence, LA | $1,418.83 | $2,364.72 | $214.47 | 6.6× |
| Baylor Scott & White Medical Center -taylor | Taylor, TX | $1,432.65 | $2,387.75 | $237.93 | 6.0× |
| Scott & White Hospital-round Rock | Round Rock, TX | $1,432.65 | $2,387.75 | $237.93 | 6.0× |
| Baylor Scott & White Medical Center - Pflugerville | Pflugerville, TX | $1,432.65 | $2,387.75 | $237.93 | 6.0× |
| Baylor Scott & White Medical Center - Buda | Buda, TX | $1,432.65 | $2,387.75 | $237.93 | 6.0× |
| Baylor Scott & White Medical Center- Austin | Austin, TX | $1,432.65 | $2,387.75 | $237.93 | 6.0× |
| Baylor Scott and White Surgical Hospital Fortworth | Fort Worth, TX | $1,450.80 | $2,418 | $238.32 | 6.1× |
| MedStar Washington Hospital Center | Washington, DC | $1,511.44 | $2,325.29 | $279.80 | 5.4× |
| Titus Regional Medical Center | Mount Pleasant, TX | $1,565.40 | $2,609 | $237.93 | 6.6× |
| Charleston Area Medical Center | Charleston, WV | $1,579 | $1,579 | $227.20 | 6.9× |
| Vanderbilt University Hospital | Nashville, TN | $1,648.08 | $3,052 | $232.50 | 7.1× |
| Baylor Scott and White Surgical Hospital Las Colin | Irving, TX | $1,675.80 | $2,793 | $237.93 | 7.0× |
| Ochsner LSU Health - Monroe Medical Center | Monroe, LA | $1,681.53 | $7,311 | $214.47 | 7.8× |
| CAMC Greenbrier Valley Medical Center | Ronceverte, WV | $1,727 | $1,727 | $227.20 | 7.6× |
| Baylor Scott & White Medical Center - Temple | Temple, TX | $1,736.03 | $2,893.38 | $237.93 | 7.3× |
| Baylor Scott & White Medical Center - Hillcrest | Waco, TX | $1,736.03 | $2,893.38 | $237.93 | 7.3× |
| Baylor Scott & White Medical Center- College Stati | College Station, TX | $1,736.03 | $2,893.38 | $237.93 | 7.3× |
| Baylor Scott & White Medical Center - Marble Falls | Marble Falls, TX | $1,736.03 | $2,893.38 | $237.93 | 7.3× |
| Baylor Scott & White Hospital Brenham | Brenham, TX | $1,736.03 | $2,893.38 | $237.93 | 7.3× |
| Summit Surgical, LLC | Hutchinson, KS | $2,019.42 | $2,524.28 | $217.82 | 9.3× |
| Ochsner LSU Health - St. Mary Medical Center | Shreveport, LA | $2,047.08 | $7,311 | $214.47 | 9.5× |
| Ochsner LSU Health - Academic Medical Center | Shreveport, LA | $2,083.64 | $7,311 | $228.51 | 9.1× |
| Texas Scottish Rite Hospital For Children | Dallas, TX | $2,091 | $2,091 | $237.93 | 8.8× |
| Treasure Valley Hospital | Boise, ID | $2,187.16 | — | $239.31 | 9.1× |
| Northwest Hills Surgical Hospital | Austin, TX | $2,519.28 | $6,998 | $237.93 | 10.6× |
| Baylor Medical Center at Trophy Club | Trophy Club, TX | $2,658 | $4,430 | $237.93 | 11.2× |
| MedStar Georgetown University Hospital | Washington, DC | $2,936.06 | $4,517.02 | $279.80 | 10.5× |
| Children's Mercy Hospital Kansas | Overland Park, KS | $3,253.68 | $6,778.50 | $224.24 | 14.5× |
| Children’s Mercy Adele Hall | Kansas City, MO | $3,253.68 | $6,778.50 | $237.23 | 13.7× |
| Massachusetts General Hospital | Boston, MA | $3,263.25 | $4,351 | $283.85 | 11.5× |
| Hilton Head Medical Center | Hilton Head Island, SC | $3,289.03 | — | $220.29 | 14.9× |
| East Cooper Medical Center | Mount Pleasant, SC | $3,289.03 | — | $220.29 | 14.9× |
| Coastal Carolina Medical Center | Hardeeville, SC | $3,289.03 | — | $220.29 | 14.9× |
| MUSC Health University Medical Center | Charleston, SC | $3,701 | $7,402 | $220.29 | 16.8× |
| Arkansas Children's Hospital | Little Rock, AR | $9,944.86 | $11,049.84 | $222.54 | 44.7× |
| Lahey Hospital & Medical Center | Burlington, MA | $10,686 | $10,686 | $283.85 | 37.6× |
| Omega Hospital | Metairie, LA | $12,139.55 | $20,810.66 | $222.32 | 54.6× |
| University of Kansas Hospital | Kansas City, KS | $18,618.52 | $93,092.60 | $221.13 | 84.2× |
| Methodist Healthcare Memphis Hospitals | Memphis, TN | $35,006.04 | $159,118.37 | $219.45 | 159.5× |
| Methodist Olive Branch Hospital | Olive Branch, MS | $35,006.04 | $159,118.37 | $219.45 | 159.5× |
| Parkland Memorial Hospital | Dallas, TX | $48,938.27 | $122,345.67 | $237.93 | 205.7× |
| Seattle Children's Hospital | Seattle, WA | $133,132.67 | — | $275.04 | 484.0× |
| University of Texas M D Anderson Cancer Center | Houston, TX | — | $5,595 | $237.93 | — |
| UAB Hospital | Birmingham, AL | — | $12,348 | $216.64 | — |
"Medicare pays" is the facility (technical) rate, matching the posted facility charge; the doctor's separate professional fee is excluded throughout. "—" means Medicare has no comparable facility rate.