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.
Original text from hospital filings
PR IMPRESS&CUST ORAL SURG SPLINT
Low
$126
Average
$1.3k
Median
$918
High
$7.5k
Each payer's average rate across its hospitals, under the methodology and billing class chosen below.
63 payers; the 90th percentile is 6.6× the 10th. Each bar is a price range and its height is how many payers fall in it. Hover a bar, or a row in the ladder, for details.
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| # | ||||||||
|---|---|---|---|---|---|---|---|---|
| 1 | UnitedHealthcare fee schedule · outpatient · +27 other terms | 500 | $263 | $1.0k | $1.7k | 172% | — | $1 – $17.9k |
| 2 | Aetna fee schedule · outpatient · +29 other terms | 451 | $283 | $1.6k | $3.7k | 228% | — | $1 – $33.6k |
| 3 | Humana fee schedule · outpatient · +25 other terms | 356 | $237 | $612 | $1.1k | 186% | — | $1 – $12.8k |
| 4 | Blue Cross Blue Shield fee schedule · outpatient · +25 other terms | 329 | $583 | $1.4k | $2.5k | 173% | — | $0 – $24.5k |
| 5 | Cigna case rate · outpatient · +18 other terms | 231 | $6.8k | $12.3k | $9.0k | 73% | — | $1 – $40.7k |
| 6 | Molina fee schedule · outpatient · +22 other terms | 205 | $208 | $288 | $693 | 241% | — | $1 – $5.4k |
| 7 | WellCare fee schedule · outpatient · +14 other terms | 170 | $235 | $336 | $545 | 162% | — | $51 – $4.3k |
| 8 | Oscar case rate · outpatient · +18 other terms | 130 | $3.0k | $2.4k | $1.1k | 44% | — | $363 – $7.5k |
| 9 | Anthem fee schedule · outpatient · +18 other terms | 122 | $527 | $1.1k | $1.2k | 113% | — | $51 – $6.3k |
| 10 | Kaiser fee schedule · outpatient · +17 other terms | 92 | $472 | $625 | $708 | 113% | — | $232 – $4.3k |
| 11 | Ambetter facility · fee schedule · outpatient · +11 other terms | 73 | $423 | $894 | $2.0k | 229% | — | $216 – $14.6k |
| 12 | Devoted fee schedule · outpatient · +8 other terms | 68 | $248 | $266 | $74 | 28% | — | $220 – $482 |
| 13 | Optum fee schedule · outpatient · +17 other terms | 65 | $260 | $478 | $546 | 114% | — | $211 – $3.8k |
| 14 | Aetna Better Health fee schedule · outpatient · +14 other terms | 63 | $111 | $132 | $80 | 61% | — | $96 – $461 |
| 15 | Healthcare Highways case rate · outpatient · +1 other terms | 55 | $2.2k | $1.9k | $482 | 26% | — | $1.2k – $3.4k |
| 16 | Caresource fee schedule · outpatient · +11 other terms | 41 | $231 | $493 | $1.0k | 210% | — | $1 – $4.3k |
| 17 | Superior Healthplan case rate · outpatient · +5 other terms | 38 | $948 | $934 | $82 | 9% | — | $349 – $948 |
| 18 | MultiPlan fee schedule · outpatient · +17 other terms | 34 | $742 | $460 | $222 | 48% | — | $218 – $1.7k |
| 19 | Bcbs Tx fee schedule · outpatient · +3 other terms | 33 | $169 | $165 | $68 | 41% | — | $80 – $427 |
| 20 | Cigna Healthspring fee schedule · outpatient · +6 other terms | 33 | $229 | $203 | $119 | 58% | — | $92 – $446 |
| 21 | Tricare other · outpatient · +13 other terms | 32 | $228 | $1.9k | $2.1k | 107% | — | $84 – $5.2k |
| 22 | Clover fee schedule · outpatient · +8 other terms | 31 | $259 | $805 | $1.3k | 167% | — | $214 – $4.4k |
| 23 | Medica case rate · outpatient · +13 other terms | 28 | $827 | $1.0k | $702 | 69% | — | $220 – $2.9k |
| 24 | Medicare fee schedule · outpatient · +12 other terms | 26 | $472 | $944 | $1.2k | 129% | — | $202 – $4.1k |
| 25 | Bcbs La fee schedule · outpatient · +1 other terms | 25 | $3.6k | $3.2k | $1.8k | 57% | — | $153 – $5.8k |
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