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
$146
Average
$1.6k
Median
$842
High
$10.1k
Each hospital's average Wellmark rate, under the methodology and billing class chosen below.
43 hospitals; the 90th percentile is 15.6× 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.
Filter by billing methodology
Filter by billing class
55 hospital rates
iThe hospitals that file a Wellmark 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 | Avera McKennan Hospital Sioux Falls, SD case rate · outpatient | 2 | $6.2k | $6.2k | — | — | 2–20 | $6.2k – $6.2k |
| 2 | Sanford USD Medical Center Sioux Falls, SD other · outpatient | 1 | $563 | $563 | — | — | 1–10 | $563 – $563 |
| 3 | St Joseph Mercy Oakland Pontiac, MI facility · fee schedule · outpatient | 1 | $1.9k | $1.9k | — | — | 1–10 | $1.9k – $1.9k |
| 4 | Allen Memorial Hospital Corporation Waterloo, IA case rate · outpatient | 1 | $218 | $218 | — | — | — | $218 – $218 |
| 5 | Ann & Robert H. Lurie Children's Hospital of Chicago Chicago, IL percent of total billed charges · inpatientfrom % of charges | 1 | $643 | $643 | — | — | — | $643 – $643 |
| 6 | Ann & Robert H. Lurie Children's Hospital of Chicago Chicago, IL percent of total billed charges · outpatientfrom % of charges | 1 | $643 | $643 | — | — | — | $643 – $643 |
| 7 | Central Iowa Hospital Corporation Des Moines, IA case rate · outpatient | 1 | $221 | $221 | — | — | — | $221 – $221 |
| 8 | Covenant Medical Center Inc Waterloo, IA facility · fee schedule · outpatient | 2 | $242 | $242 | — | — | — | $242 – $242 |
| 9 | Covenant Medical Center Inc Waterloo, IA facility · other · outpatient | 1 | $225 | $225 | — | — | — | $225 – $225 |
| 10 | Freeman Regional Health Svcs. Freeman, SD percent of total billed charges · bothfrom % of charges | 1 | $331 | $331 | — | — | — | $331 – $331 |
| 11 | Grinnell Regional Medical Center Grinnell, IA case rate · outpatient | 1 | $221 | $221 | — | — | — | $221 – $221 |
| 12 | Gundersen Palmer Lutheran Hospital and Clinic Inc West Union, IA facility · case rate · outpatient | 2 | $3.0k | $3.0k | $142 | 5% | — | $2.9k – $3.2k |
| 13 | Mercy Health Hackley Campus Muskogen, MI facility · fee schedule · outpatient | 1 | $2.1k | $2.1k | — | — | — | $2.1k – $2.1k |
| 14 | Mercy Health Saint Marys Rockford, MI facility · fee schedule · outpatient | 1 | $2.1k | $2.1k | — | — | — | $2.1k – $2.1k |
| 15 | Mercy Health Services-Iowa Corp. Mason City, IA facility · fee schedule · outpatient | 2 | $3.4k | $3.4k | — | — | — | $3.4k – $3.4k |
| 16 | Mercy Health Services-Iowa Corp. Mason City, IA facility · other · outpatient | 1 | $3.5k | $3.5k | — | — | — | $3.5k – $3.5k |
| 17 | MercyOne Genesis Aledo Medical Center Aledo, IL facility · case rate · inpatient | 1 | $3.3k | $3.3k | — | — | — | $3.3k – $3.3k |
| 18 | MercyOne Genesis Aledo Medical Center Aledo, IL facility · per diem · inpatient | 1 | $3.0k | $3.0k | — | — | — | $3.0k – $3.0k |
| 19 | MercyOne Genesis DeWitt Medical Center DeWitt, IA facility · per diem · inpatient | 2 | $1.8k | $1.8k | $876 | 49% | — | $928 – $2.7k |
| 20 | MercyOne Genesis Silvis Medical Center Silvis, IL facility · case rate · inpatient | 1 | $1.2k | $1.2k | — | — | — | $1.2k – $1.2k |
| 21 | Meriter Hospital, Inc Madison, WI per diem · outpatient | 1 | $19.7k | $19.7k | — | — | — | $19.7k – $19.7k |
| 22 | Meriter Hospital, Inc Madison, WI percent of total billed charges · inpatientfrom % of charges | 1 | $482 | $482 | — | — | — | $482 – $482 |
| 23 | Mishawaka Medical Center Mishawaka, IN facility · other · outpatient | 1 | $885 | $885 | — | — | — | $885 – $885 |
| 24 | Monument Health Network Inc Spearfish, SD fee schedule · outpatient | 1 | $3.3k | $3.3k | — | — | — | $3.3k – $3.3k |
| 25 | Monument Health Network Inc Spearfish, SD other · outpatient | 1 | $746 | $746 | — | — | — | $746 – $746 |
← Payers reporting CPT 41899 · Snapshot 20261111T120946Z-9134e7f7