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
$3
Average
$685
Median
$232
High
$6.1k
Each hospital's average Tricare rate, under the methodology and billing class chosen below.
210 hospitals; the 90th percentile is 16.6× 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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232 hospital rates
iThe hospitals that file a Tricare 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 | Massachusetts General Hospital Boston, MA other · both | 1 | $262 | $262 | — | — | 9–90 | $262 – $262 |
| 2 | METHODIST LEBONHEUR CHILDRENS HOSP TN 38301; 7691 POPLAR AVE. MEMPHIS, TN other · both | 1 | $219 | $219 | — | — | 1–10 | $219 – $219 |
| 3 | METHODIST LEBONHEUR CHILDRENS HOSP TN 38301; 7691 POPLAR AVE. MEMPHIS, TN other · outpatient | 1 | $219 | $219 | — | — | 1–10 | $219 – $219 |
| 4 | Mercy Hospital Fort Smith Smith, AR facility · other · outpatient | 1 | $225 | $225 | — | — | 1–10 | $225 – $225 |
| 5 | Mercy Hospital Fort Smith Smith, AR facility · other · outpatient | 1 | $225 | $225 | — | — | 1–10 | $225 – $225 |
| 6 | NEMOURS CHILDREN'S HOSPITAL STE 100 LAKE MARY, FL other · outpatient | 1 | $233 | $233 | — | — | 1–10 | $233 – $233 |
| 7 | NEMOURS CHILDREN'S HOSPITAL Philadelphia, PA case rate · outpatient | 1 | $243 | $243 | — | — | 1–10 | $243 – $243 |
| 8 | PRISMA HEALTH BAPTIST PARKRIDGE HOSPITAL COLUMBIA, SC other · both | 1 | $218 | $218 | — | — | 1–10 | $218 – $218 |
| 9 | PRISMA HEALTH RICHLAND HOSPITAL COLUMBIA, SC other · both | 1 | $218 | $218 | — | — | 1–10 | $218 – $218 |
| 10 | Southern Baptist Hospital of Florida, INC FL 32222; 461 Outlet Mall Blvd St. Augustine, FL facility · other · outpatient | 1 | $228 | $228 | — | — | 1–10 | $228 – $228 |
| 11 | St Tammany Hosptial Service District No 2 Slidell, LA other · outpatient | 1 | $212 | $212 | — | — | 1–10 | $212 – $212 |
| 12 | ACADIA GENERAL HOSPITAL, INC 1305 CROWLEY RAYNE HWY other · outpatient | 1 | $211 | $211 | — | — | — | $211 – $211 |
| 13 | Anderson Hospital Maryville, IL facility · fee schedule · outpatient | 1 | $246 | $246 | — | — | — | $246 – $246 |
| 14 | Ascension Cedar Park Park, TX fee schedule · outpatient | 1 | $125 | $125 | — | — | — | $125 – $125 |
| 15 | Ascension Providence Waco, TX other · inpatient | 1 | $228 | $228 | — | — | — | $228 – $228 |
| 16 | Ascension Providence Waco, TX other · outpatient | 1 | $228 | $228 | — | — | — | $228 – $228 |
| 17 | Ascension Seton Austin, TX fee schedule · outpatient | 1 | $125 | $125 | — | — | — | $125 – $125 |
| 18 | Ascension Seton Austin, TX other · inpatient | 1 | $225 | $225 | — | — | — | $225 – $225 |
| 19 | Ascension Seton Austin, TX fee schedule · outpatient | 1 | $125 | $125 | — | — | — | $125 – $125 |
| 20 | Ascension Seton Austin, TX fee schedule · outpatient | 1 | $125 | $125 | — | — | — | $125 – $125 |
| 21 | Ascension Seton Austin, TX other · inpatient | 1 | $225 | $225 | — | — | — | $225 – $225 |
| 22 | Ascension Seton Luling, TX fee schedule · outpatient | 1 | $125 | $125 | — | — | — | $125 – $125 |
| 23 | Ascension Seton Burnet, TX fee schedule · outpatient | 1 | $125 | $125 | — | — | — | $125 – $125 |
| 24 | Ascension Seton Smithville, TX fee schedule · outpatient | 1 | $125 | $125 | — | — | — | $125 – $125 |
| 25 | Ascension Seton Bastrop, TX fee schedule · outpatient | 1 | $125 | $125 | — | — | — | $125 – $125 |
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