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
Non-auto graft addl tooth
Prices here combine facility and professional fees. See them separately →Experimental
Low
$0
Average
$1.7k
Median
$716
High
$110.6k
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Showing prices across every billing methodology. Pick one in the filter above to narrow the chart. 165 hospitals; the 90th percentile is 28.9× 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.
Click a bar to filter the hospitals table to that price range.
| # | Hospital | ||||||
|---|---|---|---|---|---|---|---|
| 1 | St. Anthony Shawnee Hospital, Inc Shawnee, OK | $241 | $241 | — | — | — | $241 – $241 |
| 2 | Mayo Regional Hospital Dover Foxcroft, ME | $140 | $149 | $21 | 14% | — | $132 – $184 |
| 3 | Baptist Medical Center of the Beaches, INC Beach, FL | $767 | $772 | $48 | 6% | — | $697 – $836 |
| 4 | Westfield Memorial Hospital Inc WESTFIELD, NY | $140 | $153 | $31 | 20% | — | $129 – $225 |
| 5 | Gundersen Luthern Medical Center Inc La Crosse, WI | $486 | $1.2k | $1.5k | 128% | — | $486 – $5.6k |
| 6 | Jefferson County Hospital OK Waurika, OK | $554 | $636 | $117 | 18% | — | $526 – $826 |
| 7 | CHRISTUS Good Shepherd Hospital - Northpark Longview, TX | $85 | $85 | — | — | — | $85 – $85 |
| 8 | Fairview Hospital Cleveland, OH | $1.5k | $1.5k | $56 | 4% | — | $1.4k – $1.6k |
| 9 | University Medical Center of Southern Nevada Las Vegas, NV | $117 | $119 | $10 | 8% | — | $117 – $178 |
| 10 | Honorhealth Scottsdale Osborn Medical Center Scottsdale, AZ | $2.4k | $2.4k | — | — | — | $2.4k – $2.4k |
Ask Claude or any MCP client for HCPCS D4285 pricing at a specific hospital — see how to connect.