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
DENTAL OCCLUSAL GUARD
Low
$153
Average
$1.6k
Median
$322
High
$7.8k
Each hospital's average Blue Cross Blue Shield rate, under the methodology and billing class chosen below.
14 hospitals; the 90th percentile is 19.8× 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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26 hospital rates
iThe hospitals that file a Blue Cross Blue Shield 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 | ADVENTIST HEALTH MEDICAL CENTER TEHACHAPI Tehachapi, CA case rate · outpatient | 2 | $255 | $255 | $13 | 5% | — | $242 – $269 |
| 2 | ADVENTIST HEALTH MEDICAL CENTER TEHACHAPI Tehachapi, CA fee schedule · outpatient | 1 | $304 | $304 | — | — | — | $304 – $304 |
| 3 | ADVENTIST HEALTH MEDICAL CENTER TEHACHAPI Tehachapi, CA percent of total billed charges · outpatientfrom % of charges | 2 | $215 | $215 | $18 | 8% | — | $197 – $233 |
| 4 | ADVENTIST HEALTH MENDOCINO COAST Bragg, CA fee schedule · outpatient | 1 | $279 | $279 | — | — | — | $279 – $279 |
| 5 | ADVENTIST HEALTH MENDOCINO COAST Bragg, CA percent of total billed charges · outpatientfrom % of charges | 3 | $358 | $310 | $96 | 31% | — | $176 – $396 |
| 6 | Essentia Health St. Mary's - Detroit Lakes 1027 Washington Ave. Detroit Lakes, MN facility · fee schedule · outpatient | 1 | $7.8k | $7.8k | — | — | — | $7.8k – $7.8k |
| 7 | Essentia Health St. Mary's Children's Hospital Duluth, MN facility · fee schedule · outpatient | 1 | $4.0k | $4.0k | — | — | — | $4.0k – $4.0k |
| 8 | Essentia Health St. Mary's Medical Center Duluth, MN facility · fee schedule · outpatient | 1 | $4.0k | $4.0k | — | — | — | $4.0k – $4.0k |
| 9 | LODI MEMORIAL HOSPITAL ASSOCIATION INC Lodi, CA fee schedule · outpatient | 2 | $152 | $152 | — | — | — | $152 – $152 |
| 10 | LODI MEMORIAL HOSPITAL ASSOCIATION INC Lodi, CA percent of total billed charges · outpatientfrom % of charges | 2 | $154 | $154 | $3 | 2% | — | $151 – $157 |
| 11 | Mercy Hospitals East Communities Washington, MO professional · percent of total billed charges · inpatientfrom % of charges | 1 | $195 | $195 | — | — | — | $195 – $195 |
| 12 | Mercy Hospitals East Communities Washington, MO professional · percent of total billed charges · outpatientfrom % of charges | 1 | $195 | $195 | — | — | — | $195 – $195 |
| 13 | Providence Health System - Southern California Santa Monica, CA fee schedule · outpatient | 1 | $1.5k | $1.5k | — | — | — | $1.5k – $1.5k |
| 14 | REEDLEY COMMUNITY HOSPITAL Reedley, CA case rate · outpatient | 3 | $216 | $209 | $10 | 5% | — | $194 – $216 |
| 15 | REEDLEY COMMUNITY HOSPITAL Reedley, CA fee schedule · outpatient | 2 | $375 | $375 | — | — | — | $375 – $375 |
| 16 | REEDLEY COMMUNITY HOSPITAL Reedley, CA percent of total billed charges · outpatientfrom % of charges | 2 | $272 | $272 | $19 | 7% | — | $253 – $291 |
| 17 | SONORA COMMUNITY HOSPITAL Sonora, CA fee schedule · outpatient | 2 | $152 | $152 | — | — | — | $152 – $152 |
| 18 | SONORA COMMUNITY HOSPITAL Sonora, CA percent of total billed charges · outpatientfrom % of charges | 2 | $354 | $354 | $0 | 0% | — | $353 – $354 |
| 19 | Saratoga Hospital Saratoga Springs, NY facility · fee schedule · outpatient | 1 | $770 | $770 | — | — | — | $770 – $770 |
| 20 | Stanford Health Care Tri-Valley Livermore, CA fee schedule · outpatient | 1 | $2.6k | $2.6k | — | — | — | $2.6k – $2.6k |
| 21 | UKIAH ADVENTIST HOSPITAL Ukiah, CA case rate · outpatient | 3 | $197 | $190 | $9 | 5% | — | $177 – $197 |
| 22 | UKIAH ADVENTIST HOSPITAL Ukiah, CA fee schedule · outpatient | 2 | $280 | $280 | — | — | — | $280 – $280 |
| 23 | UKIAH ADVENTIST HOSPITAL Ukiah, CA percent of total billed charges · outpatientfrom % of charges | 2 | $179 | $179 | $1 | 1% | — | $178 – $180 |
| 24 | WILLITS HOSPITAL INC Willits, CA case rate · outpatient | 2 | $304 | $304 | — | — | — | $304 – $304 |
| 25 | WILLITS HOSPITAL INC Willits, CA fee schedule · outpatient | 2 | $403 | $403 | — | — | — | $403 – $403 |
← Payers reporting HCPCS D9940 · Snapshot 20261112T181611Z-3fa9fb76