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.
Generation details were not recorded for this description.
Original text from hospital filings
PR UNLISTED PROCEDURE DENTOALVEOLAR STRUCTURES
Low
$1
Average
$1.1k
Median
$373
High
$111.7k
Each hospital's average Molina rate, under the methodology and billing class chosen below.
587 hospitals; the 90th percentile is 11.4× the 10th. Each bar is a price range and its height is how many hospitals fall in it. Hover a bar, or a row in the ladder, for details.
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736 hospital rates
iThe hospitals that file a Molina rate for this code, one row per hospital and set of terms (billing class, payment method, setting). Rates under different terms are never blended, so the terms are shown under each hospital’s name. Figures are the hospital’s averages across its plans.| # | Plans | |||||||
|---|---|---|---|---|---|---|---|---|
| 1 | Stony Brook University Hospital Stony Brook, NY facility · other · outpatient | 1 | $1.6k | $1.6k | $33 | 2% | 23 | $1.6k – $1.7k |
| 2 | Covenant Medical Center Inc Saginaw, MI professional · other · both | 1 | $2.3k | $2.3k | — | — | 13 | $2.3k – $2.3k |
| 3 | Upstate University Hospital Syracuse, NY facility · case rate · outpatient | 2 | $1.8k | $1.8k | $684 | 37% | 11 | $1.2k – $2.5k |
| 4 | HOLLAND COMMUNITY HOSPITAL Holland, MI percent of total billed charges · outpatientfrom % of charges | 1 | $55 | $57 | $23 | 40% | 3–30 | $30 – $85 |
| 5 | St Clare Memorial Hospital Inc OCONTO FALLS, WI percent of total billed charges · outpatientfrom % of charges | 1 | $4.2k | $4.2k | — | — | 2–20 | $4.2k – $4.2k |
| 6 | Brandon HMA LLC Brandon, MS facility · other · outpatient | 2 | $185 | $185 | $6 | 3% | 1–10 | $179 – $191 |
| 7 | FLAGET HEALTHCARE, INC Bardstown, KY percent of total billed charges · outpatientfrom % of charges | 1 | $3.0k | $3.0k | — | — | 1–10 | $3.0k – $3.0k |
| 8 | HOLLAND COMMUNITY HOSPITAL Holland, MI percent of total billed charges · bothfrom % of charges | 1 | $86 | $86 | — | — | 1–10 | $86 – $86 |
| 9 | HOSPITAL OF CENTRAL CONNECTICUT AT NEW BRITAIN D/B/A THE HOSPITAL OF CENTRAL CONNECTICUT SOUTHINGTON, CT percent of total billed charges · outpatientfrom % of charges | 1 | $10.6k | $10.6k | — | — | 1–10 | $10.6k – $10.6k |
| 10 | Mercy Health Hackley Campus Muskogen, MI facility · other · outpatient | 2 | $288 | $288 | $40 | 14% | 1–10 | $248 – $329 |
| 11 | Mercy Health Services-Iowa Corp. Mason City, IA facility · other · outpatient | 1 | $3.2k | $3.2k | — | — | 1–10 | $3.2k – $3.2k |
| 12 | MultiCare Deaconess Hospital Spokane, WA other · outpatient | 1 | $49 | $49 | — | — | 1–10 | $49 – $49 |
| 13 | MultiCare Valley Hospital Spokane Valley, WA other · outpatient | 1 | $48 | $48 | — | — | 1–10 | $48 – $48 |
| 14 | PRISMA HEALTH BAPTIST EASLEY HOSPITAL EASLEY, SC fee schedule · both | 1 | $514 | $514 | — | — | 1–10 | $514 – $514 |
| 15 | PRISMA HEALTH BAPTIST PARKRIDGE HOSPITAL COLUMBIA, SC other · both | 1 | $239 | $239 | — | — | 1–10 | $239 – $239 |
| 16 | PRISMA HEALTH GREENVILLE MEMORIAL HOSPITAL GREENVILLE, SC fee schedule · both | 1 | $514 | $514 | — | — | 1–10 | $514 – $514 |
| 17 | PRISMA HEALTH RICHLAND HOSPITAL COLUMBIA, SC other · both | 1 | $239 | $239 | — | — | 1–10 | $239 – $239 |
| 18 | SAINT JOSEPH HEALTH SYSTEM, INC Lexington, KY percent of total billed charges · outpatientfrom % of charges | 1 | $2.5k | $2.5k | — | — | 1–10 | $2.5k – $2.5k |
| 19 | ST ELIZABETHS HOSPITAL OF THE HOSPITAL SISTERS OF THE THIRD ORDER OF ST FRANCIS O'Fallon, IL fee schedule · outpatient | 1 | $1.1k | $1.1k | — | — | 1–10 | $1.1k – $1.1k |
| 20 | ST JOHNS HOSPITAL OF THE HOSPITAL SISTERS OF THE THIRD ORDER OF ST FRANCIS Springfield, IL fee schedule · outpatient | 1 | $1.1k | $1.1k | — | — | 1–10 | $1.1k – $1.1k |
| 21 | Saint Alphonsus Medical Center - Nampa Nampa, ID facility · other · outpatient | 2 | $431 | $431 | $173 | 40% | 1–10 | $258 – $604 |
| 22 | Saint Alphonsus Regional Medical Center - Boise Boise, ID facility · other · outpatient | 2 | $431 | $431 | $173 | 40% | 1–10 | $258 – $604 |
| 23 | The University of Texas Southwestern Medical Center at Dallas Dallas, TX other · both | 1 | $25 | $25 | — | — | 1–10 | $25 – $25 |
| 24 | Wesley Health System LLC Hattiesburg, MS facility · other · outpatient | 2 | $185 | $185 | $6 | 3% | 1–10 | $179 – $191 |
| 25 | AKRON GENERAL MEDICAL CENTER Akron, OH facility · case rate · outpatient | 1 | $1.5k | $1.5k | — | — | — | $1.5k – $1.5k |
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