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
TREAT MOUTH ROOF FRACTURE
Low
$819
Average
$5.6k
Median
$5.3k
High
$16.7k
Each payer's average rate across its hospitals, under the methodology and billing class chosen below.
63 payers; the 90th percentile is 5.4× 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 case rate · outpatient · +25 other terms | 433 | $9.3k | $9.1k | $4.9k | 54% | 1–10 | $1 – $56.2k |
| 2 | Aetna fee schedule · outpatient · +24 other terms | 423 | $6.3k | $7.6k | $5.5k | 72% | — | $79 – $53.3k |
| 3 | Blue Cross Blue Shield fee schedule · outpatient · +22 other terms | 326 | $6.5k | $8.4k | $6.2k | 74% | — | $0 – $42.9k |
| 4 | Humana fee schedule · outpatient · +21 other terms | 291 | $5.9k | $5.5k | $2.2k | 40% | — | $544 – $23.2k |
| 5 | Cigna case rate · outpatient · +20 other terms | 227 | $6.9k | $11.1k | $8.2k | 74% | — | $1 – $40.7k |
| 6 | WellCare fee schedule · outpatient · +11 other terms | 139 | $6.1k | $6.6k | $2.0k | 30% | — | $106 – $13.9k |
| 7 | Oscar case rate · outpatient · +13 other terms | 130 | $9.4k | $8.9k | $3.1k | 35% | — | $3.5k – $17.8k |
| 8 | Molina fee schedule · outpatient · +13 other terms | 128 | $6.2k | $6.2k | $3.7k | 59% | — | $85 – $13.7k |
| 9 | Anthem fee schedule · outpatient · +18 other terms | 123 | $5.5k | $5.0k | $7.1k | 141% | — | $561 – $43.3k |
| 10 | Kaiser fee schedule · outpatient · +9 other terms | 94 | $7.5k | $9.2k | $7.4k | 81% | — | $561 – $42.0k |
| 11 | Healthcare Highways case rate · outpatient · +2 other terms | 76 | $6.4k | $7.0k | $1.1k | 16% | — | $3.4k – $8.6k |
| 12 | Devoted fee schedule · outpatient · +6 other terms | 69 | $6.0k | $5.5k | $1.7k | 32% | — | $618 – $6.7k |
| 13 | Ambetter facility · fee schedule · outpatient · +10 other terms | 61 | $10.1k | $10.2k | $2.8k | 27% | — | $887 – $15.4k |
| 14 | Superior Healthplan case rate · outpatient · +2 other terms | 38 | $948 | $1.2k | $1.4k | 116% | — | $929 – $8.9k |
| 15 | Optum fee schedule · outpatient · +10 other terms | 35 | $5.7k | $6.5k | $5.3k | 81% | — | $618 – $21.9k |
| 16 | Caresource fee schedule · outpatient · +10 other terms | 34 | $9.0k | $10.7k | $2.8k | 26% | — | $5.7k – $13.1k |
| 17 | Bcbs Tx fee schedule · outpatient · +3 other terms | 32 | $1.8k | $1.7k | $1.7k | 97% | — | $533 – $6.1k |
| 18 | Clover fee schedule · outpatient · +6 other terms | 31 | $6.5k | $6.3k | $402 | 6% | — | $5.3k – $7.0k |
| 19 | Medica case rate · outpatient · +9 other terms | 28 | $4.0k | $5.0k | $2.2k | 45% | — | $1.6k – $10.6k |
| 20 | Bcbs La fee schedule · outpatient · +2 other terms | 25 | $6.7k | $7.0k | $2.2k | 31% | — | $3.1k – $13.7k |
| 21 | Regence professional · fee schedule · outpatient · +8 other terms | 25 | $260 | $744 | $626 | 84% | — | $98 – $2.0k |
| 22 | Medicare fee schedule · outpatient · +10 other terms | 24 | $618 | $1.7k | $2.1k | 124% | — | $562 – $5.9k |
| 23 | Aetna Better Health fee schedule · outpatient · +9 other terms | 20 | $2.0k | $2.5k | $1.9k | 77% | — | $597 – $6.6k |
| 24 | First Health fee schedule · outpatient · +15 other terms | 19 | $6.3k | $8.5k | $3.9k | 46% | — | $607 – $13.8k |
| 25 | Tricare other · outpatient · +10 other terms | 19 | $5.4k | $5.4k | $1.6k | 30% | — | $2.1k – $6.9k |
← Hospitals reporting CPT 21422 · Snapshot 20261113T090226Z-3ce6c0b8