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.
Generation details were not recorded for this description.
Original text from hospital filings
Fluoride applicator
Low
$11
Average
$150
Median
$115
High
$554
Each hospital's average Aetna rate, under the methodology and billing class chosen below.
87 hospitals; the 90th percentile is 5.8× 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.
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90 hospital rates
iThe hospitals that file a Aetna 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 | AKRON GENERAL MEDICAL CENTER Akron, OH professional · percent of total billed charges · outpatientfrom % of charges | 3 | $160 | $170 | $22 | 13% | — | $150 – $200 |
| 2 | Acadia Hospital Bangor, ME professional · fee schedule · outpatient | 1 | $95 | $95 | — | — | — | $95 – $95 |
| 3 | BELLEVUE MEDICAL CENTER LLC Bellevue, NE fee schedule · outpatient | 1 | $79 | $79 | — | — | — | $79 – $79 |
| 4 | Baylor Scott & White All Saints Medical Center - Fort Worth Fort Worth, TX facility · percent of total billed charges · outpatientfrom % of charges | 3 | $110 | $88 | $39 | 45% | — | $33 – $120 |
| 5 | Baylor Scott & White Heart and Vascular Hospital - Dallas Dallas, TX facility · percent of total billed charges · outpatientfrom % of charges | 2 | $115 | $115 | $5 | 4% | — | $110 – $120 |
| 6 | Baylor Scott & White Heart and Vascular Hospital - Waxahachie Waxahachie, TX facility · percent of total billed charges · outpatientfrom % of charges | 1 | $110 | $110 | — | — | — | $110 – $110 |
| 7 | Baylor Scott & White Medical Center - Centennial Frisco, TX facility · percent of total billed charges · outpatientfrom % of charges | 1 | $110 | $110 | — | — | — | $110 – $110 |
| 8 | Baylor Scott & White Medical Center - Frisco at PGA Parkway Frisco, TX facility · percent of total billed charges · outpatientfrom % of charges | 2 | $115 | $115 | $5 | 4% | — | $110 – $120 |
| 9 | Baylor Scott & White Medical Center - Grapevine Grapevine, TX facility · percent of total billed charges · outpatientfrom % of charges | 3 | $110 | $87 | $40 | 46% | — | $31 – $120 |
| 10 | Baylor Scott & White Medical Center - Irving Irving, TX facility · percent of total billed charges · outpatientfrom % of charges | 2 | $115 | $115 | $5 | 4% | — | $110 – $120 |
| 11 | Baylor Scott & White Medical Center - Lake Pointe Rowlett, TX facility · percent of total billed charges · outpatientfrom % of charges | 1 | $110 | $110 | — | — | — | $110 – $110 |
| 12 | Baylor Scott & White Medical Center - McKinney McKinney, TX facility · percent of total billed charges · outpatientfrom % of charges | 2 | $115 | $115 | $5 | 4% | — | $110 – $120 |
| 13 | Baylor Scott & White Medical Center - Plano Plano, TX facility · percent of total billed charges · outpatientfrom % of charges | 2 | $115 | $115 | $5 | 4% | — | $110 – $120 |
| 14 | Baylor Scott & White Medical Center at Waxahachie Waxahachie, TX facility · percent of total billed charges · outpatientfrom % of charges | 2 | $115 | $115 | $5 | 4% | — | $110 – $120 |
| 15 | Baylor Scott & White The Heart Hospital - Denton Denton, TX facility · percent of total billed charges · outpatientfrom % of charges | 1 | $110 | $110 | — | — | — | $110 – $110 |
| 16 | Baylor Scott & White The Heart Hospital - McKinney McKinney, TX facility · percent of total billed charges · outpatientfrom % of charges | 1 | $110 | $110 | — | — | — | $110 – $110 |
| 17 | Baylor Scott & White The Heart Hospital - Plano Plano, TX facility · percent of total billed charges · outpatientfrom % of charges | 2 | $115 | $115 | $5 | 4% | — | $110 – $120 |
| 18 | Baylor University Medical Center Dallas, TX facility · percent of total billed charges · outpatientfrom % of charges | 2 | $115 | $115 | $5 | 4% | — | $110 – $120 |
| 19 | Berger Hospital Circleville, OH fee schedule · outpatient | 1 | $180 | $180 | — | — | — | $180 – $180 |
| 20 | Bethesda Hospital Inc. Lebanon, OH facility · fee schedule · outpatient | 1 | $223 | $223 | $2 | 1% | — | $221 – $225 |
| 21 | Blue Hill Memorial Hospital Hill, ME professional · fee schedule · outpatient | 1 | $95 | $95 | — | — | — | $95 – $95 |
| 22 | Boston Medical Center Boston, MA percent of total billed charges · bothfrom % of charges | 2 | $55 | $55 | — | — | — | $55 – $55 |
| 23 | Butler Healthcare Providers_ DBA Butler Memorial Hospital Butler, PA facility · fee schedule · outpatient | 1 | $166 | $166 | — | — | — | $166 – $166 |
| 24 | CHRISTUS Good Shepherd Hospital - Northpark Longview, TX fee schedule · outpatient | 1 | $58 | $58 | — | — | — | $58 – $58 |
| 25 | COMMUNITY MEMORIAL HOSPITAL Hill, VA case rate · outpatient | 1 | $357 | $357 | — | — | — | $357 – $357 |
← Payers reporting HCPCS D5986 · Snapshot 20261112T124536Z-e251e855