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 PERIODONTAL MUCOSAL GRAFTING
Low
$521
Average
$2.5k
Median
$2.1k
High
$11.3k
Each payer's average rate across its hospitals, under the methodology and billing class chosen below.
60 payers; the 90th percentile is 5.1× 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 · +19 other terms | 464 | $1.6k | $2.2k | $2.4k | 110% | — | $51 – $43.5k |
| 2 | Aetna fee schedule · outpatient · +18 other terms | 430 | $1.7k | $2.6k | $2.6k | 97% | — | $79 – $26.6k |
| 3 | Humana fee schedule · outpatient · +17 other terms | 334 | $1.5k | $1.6k | $1.3k | 86% | — | $304 – $15.8k |
| 4 | Blue Cross Blue Shield fee schedule · outpatient · +21 other terms | 324 | $2.9k | $3.4k | $2.9k | 83% | — | $0 – $41.4k |
| 5 | Cigna case rate · outpatient · +17 other terms | 221 | $6.8k | $11.9k | $8.5k | 71% | — | $1 – $40.7k |
| 6 | Molina fee schedule · outpatient · +13 other terms | 196 | $1.1k | $972 | $845 | 87% | — | $172 – $5.7k |
| 7 | WellCare fee schedule · outpatient · +6 other terms | 152 | $1.5k | $1.6k | $611 | 37% | — | $442 – $4.4k |
| 8 | Oscar case rate · outpatient · +14 other terms | 130 | $5.6k | $5.3k | $1.6k | 30% | — | $2.3k – $10.1k |
| 9 | Anthem fee schedule · outpatient · +15 other terms | 114 | $1.6k | $1.6k | $2.1k | 128% | — | $410 – $11.4k |
| 10 | Kaiser fee schedule · outpatient · +8 other terms | 91 | $2.2k | $2.9k | $1.7k | 59% | — | $675 – $10.9k |
| 11 | Healthcare Highways case rate · outpatient · +2 other terms | 76 | $3.7k | $4.1k | $934 | 23% | — | $2.7k – $5.5k |
| 12 | Devoted fee schedule · outpatient · +2 other terms | 68 | $1.6k | $1.6k | $85 | 5% | — | $1.4k – $1.7k |
| 13 | Aetna Better Health fee schedule · outpatient · +7 other terms | 64 | $531 | $547 | $173 | 32% | — | $313 – $1.4k |
| 14 | Ambetter fee schedule · outpatient · +6 other terms | 60 | $2.7k | $2.4k | $1.3k | 54% | — | $653 – $7.3k |
| 15 | Caresource fee schedule · outpatient · +7 other terms | 41 | $1.5k | $1.3k | $935 | 71% | — | $653 – $4.4k |
| 16 | Superior Healthplan case rate · outpatient · +4 other terms | 38 | $948 | $970 | $176 | 18% | — | $929 – $2.2k |
| 17 | Optum fee schedule · outpatient · +8 other terms | 35 | $1.6k | $2.1k | $1.1k | 52% | — | $1.4k – $5.7k |
| 18 | Bcbs Tx fee schedule · outpatient · +2 other terms | 33 | $2.0k | $1.9k | $940 | 49% | — | $421 – $5.6k |
| 19 | Amerihealth Caritas case rate · outpatient · +5 other terms | 31 | $370 | $4.7k | $4.5k | 95% | — | $350 – $10.5k |
| 20 | Clover fee schedule · outpatient · +4 other terms | 31 | $1.6k | $1.8k | $812 | 44% | — | $1.4k – $4.5k |
| 21 | Medica case rate · outpatient · +11 other terms | 28 | $2.3k | $2.3k | $712 | 31% | — | $977 – $3.2k |
| 22 | Cigna Healthspring fee schedule · outpatient · +2 other terms | 27 | $442 | $903 | $517 | 57% | — | $442 – $1.6k |
| 23 | Tricare fee schedule · outpatient · +8 other terms | 27 | $3.8k | $2.9k | $1.5k | 51% | — | $1.4k – $5.2k |
| 24 | Bcbs La fee schedule · outpatient · +2 other terms | 25 | $6.2k | $5.9k | $1.6k | 28% | — | $1.3k – $8.5k |
| 25 | First Health fee schedule · outpatient · +13 other terms | 25 | $1.6k | $2.1k | $2.4k | 116% | — | $421 – $7.6k |
← Hospitals reporting CPT 41870 · Snapshot 20261113T090226Z-3ce6c0b8