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
Provisional pontic
Low
$66
Average
$770
Median
$363
High
$8.2k
Each payer's average rate across its hospitals, under the methodology and billing class chosen below.
29 payers; the 90th percentile is 16.1× 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 | Humana fee schedule · outpatient · +5 other terms | 70 | $823 | $938 | $556 | 59% | — | $149 – $1.6k |
| 2 | Molina facility · case rate · outpatient · +5 other terms | 30 | $892 | $4.2k | $19.3k | 459% | — | $66 – $111.7k |
| 3 | Aetna fee schedule · outpatient · +8 other terms | 22 | $169 | $382 | $431 | 113% | — | $133 – $2.0k |
| 4 | UnitedHealthcare professional · fee schedule · outpatient · +9 other terms | 20 | $290 | $421 | $162 | 39% | — | $218 – $748 |
| 5 | Anthem professional · fee schedule · outpatient · +6 other terms | 16 | $217 | $519 | $499 | 96% | — | $204 – $2.0k |
| 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 | $467 | 40% | — | $63 – $1.4k |
| 8 | Blue Cross Blue Shield facility · fee schedule · outpatient · +7 other terms | 11 | $467 | $487 | $33 | 7% | — | $467 – $579 |
| 9 | Highmark fee schedule · outpatient · +1 other terms | 11 | $170 | $169 | $11 | 6% | — | $105 – $237 |
| 10 | Cigna professional · fee schedule · outpatient · +4 other terms | 10 | $202 | $198 | $8 | 4% | — | $182 – $202 |
| 11 | Aetna Better Health facility · case rate · outpatient | 7 | $80 | $79 | $1 | 1% | — | $76 – $80 |
| 12 | Amerihealth Caritas facility · case rate · outpatient · +1 other terms | 7 | $73 | $74 | $2 | 3% | — | $73 – $80 |
| 13 | MultiPlan professional · percent of total billed charges · outpatientfrom % of charges · +1 other terms | 5 | $450 | $433 | $35 | 8% | — | $363 – $450 |
| 14 | Oscar professional · percent of total billed charges · outpatientfrom % of charges | 4 | $127 | $127 | — | — | — | $127 – $127 |
| 15 | Medica fee schedule · outpatient · +3 other terms | 3 | $369 | $369 | — | — | — | $369 – $369 |
| 16 | Wellmark facility · case rate · outpatient | 3 | $253 | $222 | $70 | 32% | — | $103 – $279 |
| 17 | Medicaid facility · case rate · outpatient | 2 | $66 | $66 | — | — | — | $66 – $66 |
| 18 | Bcbs Id professional · fee schedule · outpatient | 1 | $371 | $371 | — | — | — | $371 – $371 |
| 19 | Bcbs Mn fee schedule · outpatient | 1 | $490 | $490 | — | — | — | $490 – $490 |
| 20 | Bcbs Nv fee schedule · outpatient | 1 | $234 | $234 | — | — | — | $234 – $234 |
| 21 | Bcbs Ny percent of total billed charges · bothfrom % of charges | 1 | $496 | $496 | — | — | — | $496 – $496 |
| 22 | Bcbs Tx percent of total billed charges · outpatientfrom % of charges | 1 | $295 | $295 | $33 | 11% | — | $262 – $327 |
| 23 | Bcbs Vt professional · fee schedule · outpatient | 1 | $234 | $234 | — | — | — | $234 – $234 |
| 24 | Devoted professional · percent of total billed charges · inpatientfrom % of charges · +1 other terms | 1 | $278 | $278 | — | — | — | $278 – $278 |
| 25 | Excellus percent of total billed charges · bothfrom % of charges | 1 | $496 | $496 | — | — | — | $496 – $496 |
← Hospitals reporting HCPCS D6253 · Snapshot 20261112T124536Z-e251e855