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
Bone graft peri per tooth
Low
$625
Average
$1.1k
Median
$994
High
$1.6k
Each hospital's average Wellmark rate, under the methodology and billing class chosen below.
5 hospitals; the 90th percentile is 2.4× 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
6 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 | Gundersen Palmer Lutheran Hospital and Clinic Inc West Union, IA facility · case rate · outpatient | 2 | $625 | $625 | $29 | 5% | — | $595 – $654 |
| 2 | MercyOne Genesis Aledo Medical Center Aledo, IL facility · case rate · outpatient | 1 | $690 | $690 | — | — | — | $690 – $690 |
| 3 | MercyOne Genesis Davenport Medical Center IA 52803; 2140 53rd Avenue Bettendorf, IA facility · fee schedule · outpatient | 1 | $1.6k | $1.6k | — | — | — | $1.6k – $1.6k |
| 4 | MercyOne Genesis Davenport West Medical Center Davenport, IA facility · fee schedule · outpatient | 1 | $1.6k | $1.6k | — | — | — | $1.6k – $1.6k |
| 5 | MercyOne Genesis Silvis Medical Center Silvis, IL facility · case rate · outpatient | 1 | $255 | $255 | — | — | — | $255 – $255 |
| 6 | MercyOne Genesis Silvis Medical Center Silvis, IL facility · fee schedule · outpatient | 1 | $1.7k | $1.7k | — | — | — | $1.7k – $1.7k |
← Payers reporting HCPCS D3428 · Snapshot 20261112T124536Z-e251e855