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
$1
Average
$916
Median
$864
High
$3.5k
Filter by billing methodology
Reflects a payer-specific billing methodology not covered by the standard categories.
Showing only prices reported under the other methodology. Choose another in the filter above to change the chart. 10 hospitals; the 90th percentile is 1548.9× 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 | Nationwide Children's Hospital Columbus, OH | $1.5k | $1.5k | — | — | — | $1.5k – $1.5k |
| 2 | University of Florida Health Gainesville, FL | $902 | $902 | — | — | — | $902 – $902 |
| 3 | The Union Hospital Association Dover, OH | $1 | $1 | — | — | — | $1 – $1 |
| 4 | The Cleveland Clinic Foundation Cleveland, OH | $1 | $1 | — | — | — | $1 – $1 |
| 5 | Montefiore Medical Center Bronx, NY | $3.5k | $3.5k | $452 | 13% | — | $3.1k – $4.0k |
| 6 | Nationwide Children's Hospital Toledo, Llc Toledo, OH | $1.5k | $1.5k | $7 | 0% | — | $1.5k – $1.5k |
| 7 | Akron General Medical Center Akron, OH | $1 | $1 | — | — | — | $1 – $1 |
| 8 | UF Health The Villages, FL | $864 | $864 | — | — | — | $864 – $864 |
| 9 | Cleveland Clinic Mercy Hospital Canton, OH | $1 | $1 | — | — | — | $1 – $1 |
| 10 | UF Health Leesburg, FL | $864 | $864 | — | — | — | $864 – $864 |
Ask Claude or any MCP client for HCPCS D4285 pricing at a specific hospital — see how to connect.