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
Surg exp root surf premolar
Low
$587
Average
$1.6k
Median
$1.5k
High
$5.1k
Each hospital's average Tricare rate, under the methodology and billing class chosen below.
38 hospitals; the 90th percentile is 8.7× 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
38 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 | ACADIA GENERAL HOSPITAL, INC 1305 CROWLEY RAYNE HWY other · outpatient | 1 | $1.5k | $1.5k | — | — | — | $1.5k – $1.5k |
| 2 | Beaufort Memorial Hospital Beaufort, SC facility · fee schedule · outpatient | 1 | $1.6k | $1.6k | — | — | — | $1.6k – $1.6k |
| 3 | Butler Healthcare Providers_ DBA Butler Memorial Hospital Butler, PA facility · fee schedule · outpatient | 1 | $1.6k | $1.6k | — | — | — | $1.6k – $1.6k |
| 4 | CLAIBORNE MEDICAL CENTER Tazewell, TN fee schedule · outpatient | 1 | $628 | $628 | — | — | — | $628 – $628 |
| 5 | CUMBERLAND MEDICAL CENTER, INC. Crossville, TN fee schedule · outpatient | 1 | $628 | $628 | — | — | — | $628 – $628 |
| 6 | Clarion Hospital Clarion, PA facility · fee schedule · outpatient | 1 | $1.6k | $1.6k | — | — | — | $1.6k – $1.6k |
| 7 | EAST BATON ROUGE MEDICAL CENTER, LLC Baton Rouge, LA other · outpatient | 1 | $1.5k | $1.5k | — | — | — | $1.5k – $1.5k |
| 8 | FORT LOUDOUN MEDICAL CENTER Lenoir City, TN fee schedule · outpatient | 1 | $587 | $587 | — | — | — | $587 – $587 |
| 9 | FORT SANDERS REGIONAL MEDICAL CENTER Knoxville, TN fee schedule · outpatient | 1 | $587 | $587 | — | — | — | $587 – $587 |
| 10 | Gerald Champion Regional Medical Center Alamogordo, NM fee schedule · outpatient | 5 | $839 | $839 | — | — | — | $839 – $839 |
| 11 | HOSPITAL SERVICE DISTRICT NO. 1 OF THE PARISH OF ST. CHARLES, STATE OF LOUISIANA LULING, LA other · outpatient | 1 | $1.0k | $1.0k | $426 | 42% | — | $599 – $1.5k |
| 12 | HOSPITAL SERVICE DISTRICT OF THE PARISH OF ST. BERNARD, STATE OF LOUISIANA Chalmette, LA other · outpatient | 1 | $1.5k | $1.5k | — | — | — | $1.5k – $1.5k |
| 13 | IHC Health Services Inc., DBA Intermountain Primary Children's Hospital City, UT facility · fee schedule · outpatient | 1 | $1.6k | $1.6k | — | — | — | $1.6k – $1.6k |
| 14 | IHC Health Services Inc., DBA Intermountain Primary Children's Hospital Lehi, UT facility · fee schedule · outpatient | 1 | $1.6k | $1.6k | — | — | — | $1.6k – $1.6k |
| 15 | Kaleida Health Buffalo, NY fee schedule · outpatient | 1 | $767 | $767 | — | — | — | $767 – $767 |
| 16 | LAFAYETTE GENERAL MEDICAL CENTER INC Lafayette, LA other · outpatient | 1 | $1.5k | $1.5k | — | — | — | $1.5k – $1.5k |
| 17 | LECONTE MEDICAL CENTER Sevierville, TN fee schedule · outpatient | 1 | $628 | $628 | — | — | — | $628 – $628 |
| 18 | METHODIST MEDICAL CENTER OF OAK RIDGE Oak Ridge, TN fee schedule · outpatient | 1 | $587 | $587 | — | — | — | $587 – $587 |
| 19 | MORRISTOWN HAMBLEN HOSPITAL ASSOCIATION Morristown, TN fee schedule · outpatient | 1 | $587 | $587 | — | — | — | $587 – $587 |
| 20 | NATIONWIDE CHILDREN'S HOSPITAL TOLEDO, LLC Toledo, OH facility · fee schedule · outpatient | 1 | $1.6k | $1.6k | — | — | — | $1.6k – $1.6k |
| 21 | Nationwide Children's Hospital Columbus, OH facility · fee schedule · outpatient | 1 | $1.6k | $1.6k | — | — | — | $1.6k – $1.6k |
| 22 | Northside Hospital, Inc. Lawrenceville, GA fee schedule · outpatient | 1 | $5.1k | $5.1k | — | — | — | $5.1k – $5.1k |
| 23 | Northside Hospital, Inc. Atlanta, GA fee schedule · outpatient | 1 | $5.1k | $5.1k | — | — | — | $5.1k – $5.1k |
| 24 | Northside Hospital, Inc. Cumming, GA fee schedule · outpatient | 1 | $5.1k | $5.1k | — | — | — | $5.1k – $5.1k |
| 25 | Northside Hospital, Inc. Duluth, GA fee schedule · outpatient | 1 | $5.1k | $5.1k | — | — | — | $5.1k – $5.1k |
← Payers reporting HCPCS D3502 · Snapshot 20261112T124536Z-e251e855