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
Soft tissue graft addl tooth
Low
$0
Average
$1.5k
Median
$788
High
$7.7k
Each payer's average rate across its hospitals, under the methodology and billing class chosen below.
26 payers; the 90th percentile is 19.0× 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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Filter by billing class
| # | ||||||||
|---|---|---|---|---|---|---|---|---|
| 1 | Aetna fee schedule · outpatient · +7 other terms | 48 | $4.7k | $5.9k | $6.7k | 113% | — | $79 – $33.6k |
| 2 | Molina facility · case rate · outpatient · +6 other terms | 30 | $1.5k | $4.6k | $19.2k | 416% | — | $279 – $111.7k |
| 3 | UnitedHealthcare fee schedule · outpatient · +7 other terms | 23 | $311 | $432 | $429 | 99% | — | $26 – $1.9k |
| 4 | Cigna facility · fee schedule · outpatient · +5 other terms | 17 | $4.2k | $4.1k | $1.4k | 35% | — | $2.8k – $9.4k |
| 5 | Anthem facility · case rate · outpatient · +6 other terms | 15 | $1.5k | $8.6k | $26.7k | 309% | — | $1.5k – $108.4k |
| 6 | Blue Cross Blue Shield fee schedule · outpatient · +4 other terms | 15 | $6.4k | $4.1k | $4.0k | 96% | — | $203 – $13.2k |
| 7 | Caresource facility · case rate · outpatient · +2 other terms | 15 | $1.5k | $8.6k | $26.7k | 309% | — | $1.4k – $108.4k |
| 8 | Optum facility · case rate · outpatient · +2 other terms | 13 | $1.4k | $1.3k | $251 | 20% | — | $662 – $1.4k |
| 9 | Humana fee schedule · outpatient · +3 other terms | 11 | $756 | $909 | $596 | 66% | — | $218 – $2.0k |
| 10 | Highmark fee schedule · outpatient · +2 other terms | 10 | $89 | $89 | — | — | — | $89 – $89 |
| 11 | Oscar facility · fee schedule · outpatient · +1 other terms | 8 | $4.7k | $4.7k | — | — | — | $4.7k – $4.7k |
| 12 | Aetna Better Health facility · case rate · outpatient · +1 other terms | 7 | $836 | $847 | $48 | 6% | — | $802 – $1.0k |
| 13 | Amerihealth Caritas facility · case rate · outpatient · +1 other terms | 7 | $767 | $777 | $24 | 3% | — | $767 – $836 |
| 14 | Medica fee schedule · outpatient · +2 other terms | 5 | $339 | $297 | $72 | 24% | — | $219 – $390 |
| 15 | MultiPlan professional · percent of total billed charges · outpatientfrom % of charges · +1 other terms | 4 | $900 | $900 | — | — | — | $900 – $900 |
| 16 | Wellmark facility · case rate · outpatient | 3 | $3.3k | $2.9k | $921 | 32% | — | $1.4k – $3.7k |
| 17 | Medicaid facility · case rate · outpatient | 2 | $697 | $697 | — | — | — | $697 – $697 |
| 18 | Bcbs Id professional · fee schedule · outpatient | 1 | $419 | $419 | — | — | — | $419 – $419 |
| 19 | Bcbs Mn fee schedule · outpatient | 1 | $0 | $0 | — | — | — | $0 – $0 |
| 20 | Bcbs Nv fee schedule · outpatient | 1 | $165 | $165 | — | — | — | $165 – $165 |
| 21 | Bcbs Tx percent of total billed charges · outpatientfrom % of charges | 1 | $244 | $244 | $27 | 11% | — | $217 – $271 |
| 22 | Bcbs Vt professional · fee schedule · outpatient | 1 | $185 | $185 | — | — | — | $185 – $185 |
| 23 | Magellan fee schedule · outpatient | 1 | $230 | $230 | — | — | — | $230 – $230 |
| 24 | Regence facility · fee schedule · outpatient | 1 | $288 | $288 | — | — | — | $288 – $288 |
| 25 | Tricare percent of total billed charges · bothfrom % of charges | 1 | $394 | $394 | — | — | — | $394 – $394 |
← Hospitals reporting HCPCS D4278 · Snapshot 20261112T124536Z-e251e855