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
Removal of an indirect restoration on a natural tooth
Low
$76
Average
$2.6k
Median
$1.7k
High
$8.2k
Each payer's average rate across its hospitals, under the methodology and billing class chosen below.
18 payers; the 90th percentile is 10.1× the 10th. Each bar is a price range and its height is how many payers fall in it. Hover a bar, or a row in the ladder, for details.
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| # | ||||||||
|---|---|---|---|---|---|---|---|---|
| 1 | UnitedHealthcare case rate · outpatient · +7 other terms | 187 | $7.6k | $7.4k | $3.7k | 50% | — | $204 – $30k |
| 2 | Molina facility · case rate · outpatient · +3 other terms | 23 | $1.5k | $5.9k | $21.6k | 364% | — | $1.4k – $111.7k |
| 3 | Blue Cross Blue Shield facility · fee schedule · outpatient · +3 other terms | 16 | $177 | $1.3k | $1.1k | 86% | — | $137 – $4.2k |
| 4 | Anthem facility · case rate · outpatient · +4 other terms | 15 | $1.5k | $8.6k | $26.7k | 309% | — | $1.5k – $108.4k |
| 5 | Caresource facility · case rate · outpatient · +1 other terms | 15 | $1.5k | $8.6k | $26.7k | 309% | — | $1.4k – $108.4k |
| 6 | Aetna case rate · outpatient · +6 other terms | 14 | $3.0k | $3.0k | $1.4k | 46% | — | $678 – $6.5k |
| 7 | Cigna case rate · outpatient · +2 other terms | 13 | $2.4k | $2.7k | $1.1k | 41% | — | $1.2k – $5.1k |
| 8 | Optum facility · case rate · outpatient · +1 other terms | 13 | $1.4k | $1.4k | $13 | 1% | — | $1.3k – $1.4k |
| 9 | Aetna Better Health facility · case rate · outpatient | 6 | $1.7k | $1.7k | — | — | — | $1.7k – $1.7k |
| 10 | Amerihealth Caritas facility · case rate · outpatient · +1 other terms | 6 | $1.5k | $1.5k | — | — | — | $1.5k – $1.5k |
| 11 | Humana facility · case rate · outpatient · +2 other terms | 5 | $1.4k | $1.4k | $68 | 5% | — | $1.4k – $1.5k |
| 12 | First Health other · outpatient · +2 other terms | 3 | $2.7k | $2.6k | $130 | 5% | — | $2.4k – $2.7k |
| 13 | Medicaid facility · case rate · outpatient | 2 | $1.4k | $1.4k | — | — | — | $1.4k – $1.4k |
| 14 | Bcbs Al other · outpatient | 1 | $5.5k | $5.5k | — | — | — | $5.5k – $5.5k |
| 15 | Bcbs Mn fee schedule · outpatient | 1 | $2.6k | $2.6k | $1.1k | 44% | — | $918 – $3.7k |
| 16 | MultiPlan facility · percent of total billed charges · inpatientfrom % of charges · +2 other terms | 1 | $230 | $230 | — | — | — | $230 – $230 |
| 17 | Oscar professional · percent of total billed charges · outpatientfrom % of charges | 1 | $76 | $76 | — | — | — | $76 – $76 |
| 18 | WellCare facility · case rate · outpatient | 1 | $1.4k | $1.4k | — | — | — | $1.4k – $1.4k |
← Hospitals reporting HCPCS D2956 · Snapshot 20261113T090226Z-3ce6c0b8