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
Limited dental tx adolescent
Low
$24
Average
$5.4k
Median
$2.1k
High
$42.0k
Each payer's average rate across its hospitals, under the methodology and billing class chosen below.
30 payers; the 90th percentile is 34.4× 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 · +6 other terms | 29 | $1.5k | $4.9k | $19.5k | 394% | — | $964 – $111.7k |
| 2 | Aetna fee schedule · outpatient · +7 other terms | 24 | $1.6k | $1.8k | $1.5k | 84% | — | $79 – $6.8k |
| 3 | UnitedHealthcare facility · case rate · outpatient · +8 other terms | 19 | $1.5k | $14.4k | $24.9k | 173% | — | $964 – $111.7k |
| 4 | Anthem facility · case rate · outpatient · +5 other terms | 15 | $1.5k | $8.6k | $26.7k | 309% | — | $1.5k – $108.4k |
| 5 | Caresource facility · case rate · outpatient · +1 other terms | 15 | $1.5k | $8.6k | $26.7k | 309% | — | $1.4k – $108.4k |
| 6 | MultiPlan facility · percent of total billed charges · outpatientfrom % of charges · +1 other terms | 13 | $116 | $122 | $20 | 17% | — | $116 – $193 |
| 7 | Optum facility · case rate · outpatient · +2 other terms | 13 | $1.4k | $1.3k | $160 | 12% | — | $916 – $1.4k |
| 8 | Blue Cross Blue Shield facility · fee schedule · outpatient · +5 other terms | 12 | $4.1k | $4.7k | $4.0k | 86% | — | $505 – $22k |
| 9 | Humana fee schedule · outpatient · +4 other terms | 11 | $3.3k | $2.5k | $846 | 34% | — | $1.0k – $3.5k |
| 10 | Cigna professional · fee schedule · outpatient · +5 other terms | 10 | $800 | $765 | $50 | 7% | — | $691 – $800 |
| 11 | Clover facility · percent of total billed charges · outpatientfrom % of charges | 10 | $24 | $24 | — | — | — | $24 – $24 |
| 12 | Highmark fee schedule · outpatient · +1 other terms | 10 | $1.8k | $1.8k | — | — | — | $1.8k – $1.8k |
| 13 | Aetna Better Health facility · case rate · outpatient | 7 | $1.2k | $1.2k | $15 | 1% | — | $1.1k – $1.2k |
| 14 | Amerihealth Caritas facility · case rate · outpatient · +2 other terms | 7 | $1.1k | $1.1k | $34 | 3% | — | $1.1k – $1.2k |
| 15 | Medica fee schedule · outpatient · +2 other terms | 5 | $1.4k | $958 | $431 | 45% | — | $263 – $1.4k |
| 16 | Tricare facility · fee schedule · outpatient · +1 other terms | 5 | $50k | $50k | — | — | — | $50k – $50k |
| 17 | Wellmark facility · case rate · outpatient | 3 | $3.7k | $3.2k | $1.0k | 32% | — | $1.5k – $4.1k |
| 18 | Medicaid facility · case rate · outpatient | 2 | $964 | $964 | — | — | — | $964 – $964 |
| 19 | Bcbs Id professional · fee schedule · outpatient | 1 | $4.2k | $4.2k | — | — | — | $4.2k – $4.2k |
| 20 | Bcbs Mn fee schedule · outpatient | 1 | $4.3k | $4.3k | — | — | — | $4.3k – $4.3k |
| 21 | Bcbs Nv fee schedule · outpatient | 1 | $813 | $813 | — | — | — | $813 – $813 |
| 22 | Bcbs Tx percent of total billed charges · outpatientfrom % of charges | 1 | $1.8k | $1.8k | $195 | 11% | — | $1.6k – $1.9k |
| 23 | Bcbs Vt professional · fee schedule · outpatient | 1 | $1.1k | $1.1k | — | — | — | $1.1k – $1.1k |
| 24 | Excellus facility · fee schedule · outpatient | 1 | $22k | $22k | — | — | — | $22k – $22k |
| 25 | First Health facility · other · outpatient · +2 other terms | 1 | $35k | $35k | — | — | — | $35k – $35k |
← Hospitals reporting HCPCS D8030 · Snapshot 20261112T124536Z-e251e855