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
$49
Average
$12.6k
Median
$78
High
$50k
Each hospital's average Tricare rate, under the methodology and billing class chosen below.
16 hospitals; the 90th percentile is 754.1× 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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17 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 | Bon Secours Community Hospital Jervis, NY facility · fee schedule · outpatient | 1 | $50k | $50k | — | — | — | $50k – $50k |
| 2 | Charleston Area Medical Center Charleston, WV percent of total billed charges · bothfrom % of charges | 1 | $55 | $55 | — | — | — | $55 – $55 |
| 3 | Charleston Area Medical Center Charleston, WV percent of total billed charges · outpatientfrom % of charges | 1 | $55 | $55 | — | — | — | $55 – $55 |
| 4 | Good Samaritan Hospital Suffern, NY facility · fee schedule · outpatient | 1 | $50k | $50k | — | — | — | $50k – $50k |
| 5 | Mid Hudson Regional Hospital Poughkeepsie, NY facility · fee schedule · outpatient | 1 | $25.1k | $25.1k | $24.9k | 100% | — | $117 – $50k |
| 6 | Nationwide Children's Hospital Columbus, OH professional · percent of total billed charges · outpatientfrom % of charges | 1 | $49 | $49 | — | — | — | $49 – $49 |
| 7 | PRISMA HEALTH BAPTIST EASLEY HOSPITAL EASLEY, SC fee schedule · both | 1 | $78 | $78 | — | — | — | $78 – $78 |
| 8 | PRISMA HEALTH BLOUNT MEMORIAL HOSPITAL MARYVILLE, TN fee schedule · both | 1 | $78 | $78 | — | — | — | $78 – $78 |
| 9 | PRISMA HEALTH GREENVILLE MEMORIAL HOSPITAL GREENVILLE, SC fee schedule · both | 1 | $78 | $78 | — | — | — | $78 – $78 |
| 10 | PRISMA HEALTH GREER MEMORIAL HOSPITAL GREER, SC fee schedule · both | 1 | $78 | $78 | — | — | — | $78 – $78 |
| 11 | PRISMA HEALTH HILLCREST HOSPITAL SIMPSONVILLE, SC fee schedule · both | 1 | $78 | $78 | — | — | — | $78 – $78 |
| 12 | PRISMA HEALTH LAURENS COUNTY HOSPITAL CLINTON, SC fee schedule · both | 1 | $78 | $78 | — | — | — | $78 – $78 |
| 13 | PRISMA HEALTH NORTH GREENVILLE LTACH HOSPITAL TRAVELERS REST, SC fee schedule · both | 1 | $78 | $78 | — | — | — | $78 – $78 |
| 14 | PRISMA HEALTH OCONEE MEMORIAL HOSPITAL SENECA, SC fee schedule · both | 1 | $78 | $78 | — | — | — | $78 – $78 |
| 15 | PRISMA HEALTH PATEWOOD HOSPITAL GREENVILLE, SC fee schedule · both | 1 | $78 | $78 | — | — | — | $78 – $78 |
| 16 | St Anthony Community Hospital Warwick, NY facility · fee schedule · outpatient | 1 | $50k | $50k | — | — | — | $50k – $50k |
| 17 | Westchester Medical Center Valhalla, NY facility · fee schedule · outpatient | 1 | $25.1k | $25.1k | $24.9k | 100% | — | $117 – $50k |
← Payers reporting HCPCS D1120 · Snapshot 20261111T120946Z-9134e7f7