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
Peridontal medicament
Low
$115
Average
$1.7k
Median
$321
High
$8.6k
Each payer's average rate across its hospitals, under the methodology and billing class chosen below.
13 payers; the 90th percentile is 38.0× 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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| # | ||||||||
|---|---|---|---|---|---|---|---|---|
| 1 | Molina facility · case rate · outpatient · +3 other terms | 27 | $1.5k | $4.7k | $20.2k | 435% | — | $115 – $111.7k |
| 2 | UnitedHealthcare facility · case rate · outpatient · +4 other terms | 18 | $1.5k | $7.0k | $24.7k | 351% | — | $115 – $111.7k |
| 3 | Anthem facility · case rate · outpatient · +4 other terms | 15 | $1.5k | $8.6k | $26.7k | 309% | — | $1.5k – $108.4k |
| 4 | Caresource facility · case rate · outpatient | 15 | $1.5k | $8.6k | $26.7k | 309% | — | $1.4k – $108.4k |
| 5 | Optum facility · case rate · outpatient | 13 | $1.4k | $1.2k | $451 | 39% | — | $109 – $1.4k |
| 6 | Humana facility · case rate · outpatient · +2 other terms | 8 | $115 | $119 | $6 | 5% | — | $115 – $126 |
| 7 | Aetna Better Health facility · case rate · outpatient | 7 | $138 | $139 | $5 | 4% | — | $132 – $157 |
| 8 | Amerihealth Caritas facility · case rate · outpatient · +1 other terms | 7 | $126 | $128 | $4 | 3% | — | $126 – $138 |
| 9 | Aetna facility · case rate · outpatient · +2 other terms | 5 | $138 | $171 | $66 | 39% | — | $115 – $303 |
| 10 | Blue Cross Blue Shield facility · case rate · outpatient | 4 | $329 | $321 | $103 | 32% | — | $211 – $474 |
| 11 | Wellmark facility · case rate · outpatient | 3 | $512 | $450 | $142 | 32% | — | $209 – $566 |
| 12 | Medicaid facility · case rate · outpatient | 2 | $115 | $115 | — | — | — | $115 – $115 |
| 13 | WellCare facility · case rate · outpatient | 1 | $115 | $115 | — | — | — | $115 – $115 |
← Hospitals reporting HCPCS D5994 · Snapshot 20261112T181611Z-3fa9fb76