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
HC Dental Prophylaxis Child
Low
$37
Average
$83
Median
$39
High
$1.0k
Each hospital's average Ambetter rate, under the methodology and billing class chosen below.
24 hospitals; the 90th percentile is 1.0× 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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24 hospital rates
iThe hospitals that file a Ambetter 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 | Arkansas Childrens Hospital Little Rock, AR facility · percent of total billed charges · outpatientfrom % of charges | 1 | $91 | $91 | — | — | 1–10 | $91 – $91 |
| 2 | PRISMA HEALTH BAPTIST EASLEY HOSPITAL EASLEY, SC percent of total billed charges · bothfrom % of charges | 1 | $40 | $40 | — | — | 1–10 | $40 – $40 |
| 3 | PRISMA HEALTH GREENVILLE MEMORIAL HOSPITAL GREENVILLE, SC percent of total billed charges · bothfrom % of charges | 1 | $40 | $40 | — | — | 1–10 | $40 – $40 |
| 4 | Baylor Scott & White All Saints Medical Center - Fort Worth Fort Worth, TX facility · percent of total billed charges · outpatientfrom % of charges | 1 | $39 | $39 | — | — | — | $39 – $39 |
| 5 | Baylor Scott & White Heart and Vascular Hospital - Dallas Dallas, TX facility · percent of total billed charges · outpatientfrom % of charges | 1 | $39 | $39 | — | — | — | $39 – $39 |
| 6 | Baylor Scott & White Medical Center - Centennial Frisco, TX facility · percent of total billed charges · outpatientfrom % of charges | 1 | $39 | $39 | — | — | — | $39 – $39 |
| 7 | Baylor Scott & White Medical Center - Frisco at PGA Parkway Frisco, TX facility · percent of total billed charges · outpatientfrom % of charges | 1 | $39 | $39 | — | — | — | $39 – $39 |
| 8 | Baylor Scott & White Medical Center - Grapevine Grapevine, TX facility · percent of total billed charges · outpatientfrom % of charges | 1 | $39 | $39 | — | — | — | $39 – $39 |
| 9 | Baylor Scott & White Medical Center - Irving Irving, TX facility · percent of total billed charges · outpatientfrom % of charges | 1 | $39 | $39 | — | — | — | $39 – $39 |
| 10 | Baylor Scott & White Medical Center - Lake Pointe Rowlett, TX facility · percent of total billed charges · outpatientfrom % of charges | 1 | $39 | $39 | — | — | — | $39 – $39 |
| 11 | Baylor Scott & White Medical Center - McKinney McKinney, TX facility · percent of total billed charges · outpatientfrom % of charges | 1 | $39 | $39 | — | — | — | $39 – $39 |
| 12 | Baylor Scott & White Medical Center - Plano Plano, TX facility · percent of total billed charges · outpatientfrom % of charges | 1 | $39 | $39 | — | — | — | $39 – $39 |
| 13 | Baylor Scott & White Medical Center at Waxahachie Waxahachie, TX facility · percent of total billed charges · outpatientfrom % of charges | 1 | $39 | $39 | — | — | — | $39 – $39 |
| 14 | Baylor Scott & White The Heart Hospital - Denton Denton, TX facility · percent of total billed charges · outpatientfrom % of charges | 1 | $39 | $39 | — | — | — | $39 – $39 |
| 15 | Baylor Scott & White The Heart Hospital - Plano Plano, TX facility · percent of total billed charges · outpatientfrom % of charges | 1 | $39 | $39 | — | — | — | $39 – $39 |
| 16 | Baylor University Medical Center Dallas, TX facility · percent of total billed charges · outpatientfrom % of charges | 1 | $39 | $39 | — | — | — | $39 – $39 |
| 17 | Covenant Medical Center Inc Waterloo, IA facility · other · outpatient | 1 | $1.0k | $1.0k | — | — | — | $1.0k – $1.0k |
| 18 | PRISMA HEALTH GREER MEMORIAL HOSPITAL GREER, SC percent of total billed charges · bothfrom % of charges | 1 | $40 | $40 | — | — | — | $40 – $40 |
| 19 | PRISMA HEALTH HILLCREST HOSPITAL SIMPSONVILLE, SC percent of total billed charges · bothfrom % of charges | 1 | $40 | $40 | — | — | — | $40 – $40 |
| 20 | PRISMA HEALTH LAURENS COUNTY HOSPITAL CLINTON, SC percent of total billed charges · bothfrom % of charges | 1 | $40 | $40 | — | — | — | $40 – $40 |
| 21 | PRISMA HEALTH NORTH GREENVILLE LTACH HOSPITAL TRAVELERS REST, SC percent of total billed charges · bothfrom % of charges | 1 | $40 | $40 | — | — | — | $40 – $40 |
| 22 | PRISMA HEALTH OCONEE MEMORIAL HOSPITAL SENECA, SC percent of total billed charges · bothfrom % of charges | 1 | $40 | $40 | — | — | — | $40 – $40 |
| 23 | PRISMA HEALTH PATEWOOD HOSPITAL GREENVILLE, SC percent of total billed charges · bothfrom % of charges | 1 | $40 | $40 | — | — | — | $40 – $40 |
| 24 | University Medical Center of Southern Nevada Las Vegas, NV fee schedule · outpatient | 1 | $37 | $37 | — | — | — | $37 – $37 |
← Payers reporting HCPCS D1120 · Snapshot 20261111T120946Z-9134e7f7