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
Auto tissue graft addl tooth
Low
$0
Average
$1.2k
Median
$590
High
$8.2k
Each payer's average rate across its hospitals, under the methodology and billing class chosen below.
23 payers; the 90th percentile is 21.3× 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.
Filter by billing methodology
Filter by billing class
| # | ||||||||
|---|---|---|---|---|---|---|---|---|
| 1 | Molina facility · case rate · outpatient · +5 other terms | 30 | $1.4k | $4.6k | $19.2k | 422% | — | $207 – $111.7k |
| 2 | Blue Cross Blue Shield facility · fee schedule · outpatient · +4 other terms | 22 | $2.1k | $1.4k | $1.6k | 113% | — | $0 – $5.1k |
| 3 | Aetna fee schedule · outpatient · +5 other terms | 20 | $359 | $503 | $414 | 82% | — | $86 – $1.3k |
| 4 | UnitedHealthcare professional · fee schedule · outpatient · +6 other terms | 19 | $230 | $319 | $121 | 38% | — | $166 – $533 |
| 5 | Anthem facility · case rate · outpatient · +6 other terms | 15 | $1.5k | $8.6k | $26.7k | 309% | — | $1.5k – $108.4k |
| 6 | Caresource facility · case rate · outpatient · +1 other terms | 15 | $1.5k | $8.6k | $26.7k | 309% | — | $1.4k – $108.4k |
| 7 | Optum facility · case rate · outpatient · +1 other terms | 13 | $1.4k | $1.2k | $263 | 21% | — | $631 – $1.4k |
| 8 | Highmark fee schedule · outpatient · +2 other terms | 11 | $138 | $142 | $27 | 19% | — | $138 – $424 |
| 9 | Cigna professional · fee schedule · outpatient · +1 other terms | 10 | $154 | $142 | $18 | 12% | — | $116 – $154 |
| 10 | Humana facility · case rate · outpatient · +2 other terms | 8 | $664 | $689 | $32 | 5% | — | $664 – $730 |
| 11 | Aetna Better Health facility · case rate · outpatient | 7 | $797 | $786 | $29 | 4% | — | $686 – $797 |
| 12 | Amerihealth Caritas facility · case rate · outpatient · +2 other terms | 7 | $730 | $740 | $23 | 3% | — | $730 – $797 |
| 13 | MultiPlan professional · percent of total billed charges · outpatientfrom % of charges | 4 | $540 | $540 | — | — | — | $540 – $540 |
| 14 | Oscar professional · percent of total billed charges · outpatientfrom % of charges | 4 | $152 | $152 | — | — | — | $152 – $152 |
| 15 | Medica fee schedule · outpatient · +2 other terms | 3 | $282 | $282 | — | — | — | $282 – $282 |
| 16 | Wellmark facility · case rate · outpatient | 3 | $2.2k | $2.0k | $621 | 32% | — | $915 – $2.5k |
| 17 | Medicaid facility · case rate · outpatient | 2 | $664 | $664 | — | — | — | $664 – $664 |
| 18 | Bcbs Id professional · fee schedule · outpatient | 1 | $450 | $450 | — | — | — | $450 – $450 |
| 19 | Bcbs Mn fee schedule · outpatient | 1 | $0 | $0 | — | — | — | $0 – $0 |
| 20 | Bcbs Nv fee schedule · outpatient | 1 | $137 | $137 | — | — | — | $137 – $137 |
| 21 | Bcbs Vt professional · fee schedule · outpatient | 1 | $527 | $527 | — | — | — | $527 – $527 |
| 22 | Regence facility · fee schedule · outpatient | 1 | $239 | $239 | — | — | — | $239 – $239 |
| 23 | WellCare facility · case rate · outpatient | 1 | $664 | $664 | — | — | — | $664 – $664 |
← Hospitals reporting HCPCS D4283 · Snapshot 20261112T181611Z-3fa9fb76