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
Repl cushions for jaw motion
Low
$1
Average
$26
Median
$15
High
$2.7k
Each hospital's average Aetna rate, under the methodology and billing class chosen below.
393 hospitals; the 90th percentile is 1.4× 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.
Filter by billing methodology
Filter by billing class
414 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 | ALLE-KISKI MEDICAL CENTER NATRONA HEIGHTS, PA fee schedule · outpatient | 2 | $26 | $26 | $11 | 42% | — | $15 – $37 |
| 2 | Acadia Hospital Bangor, ME professional · fee schedule · outpatient | 1 | $9 | $9 | — | — | — | $9 – $9 |
| 3 | Adena Health System Chillicothe, OH facility · fee schedule · outpatient | 1 | $15 | $15 | — | — | — | $15 – $15 |
| 4 | Allen Memorial Hospital Corporation Waterloo, IA case rate · outpatient | 1 | $15 | $15 | — | — | — | $15 – $15 |
| 5 | Allen Memorial Hospital Corporation Waterloo, IA fee schedule · both | 2 | $17 | $17 | $0 | 1% | — | $17 – $17 |
| 6 | Alta Newport Hospital, LLC Tustin, CA facility · case rate · outpatient | 4 | $11 | $13 | $3 | 26% | — | $10 – $19 |
| 7 | American Hospital Management Corporation Arcata, CA facility · case rate · outpatient | 1 | $15 | $15 | — | — | — | $15 – $15 |
| 8 | Atrium Health Hospitals Inc Kings Mountain, NC fee schedule · outpatient | 1 | $15 | $15 | — | — | — | $15 – $15 |
| 9 | Atrium Health Hospitals Inc Lincolnton, NC fee schedule · outpatient | 1 | $15 | $15 | — | — | — | $15 – $15 |
| 10 | Atrium Health Hospitals Inc Wadesboro, NC fee schedule · outpatient | 1 | $15 | $15 | — | — | — | $15 – $15 |
| 11 | Baylor Scott & White Continuing Care Hospital Temple, TX facility · percent of total billed charges · outpatientfrom % of charges | 1 | $81 | $81 | — | — | — | $81 – $81 |
| 12 | Baylor Scott & White McLane Children's Medical Center Temple, TX facility · percent of total billed charges · outpatientfrom % of charges | 1 | $59 | $59 | — | — | — | $59 – $59 |
| 13 | Baylor Scott & White Medical Center - Austin Austin, TX facility · percent of total billed charges · outpatientfrom % of charges | 1 | $59 | $59 | — | — | — | $59 – $59 |
| 14 | Baylor Scott & White Medical Center - Brenham Brenham, TX facility · percent of total billed charges · outpatientfrom % of charges | 1 | $59 | $59 | — | — | — | $59 – $59 |
| 15 | Baylor Scott & White Medical Center - Buda Buda, TX facility · percent of total billed charges · outpatientfrom % of charges | 1 | $59 | $59 | — | — | — | $59 – $59 |
| 16 | Baylor Scott & White Medical Center - College Station College Station, TX facility · percent of total billed charges · outpatientfrom % of charges | 1 | $59 | $59 | — | — | — | $59 – $59 |
| 17 | Baylor Scott & White Medical Center - Hillcrest Waco, TX facility · percent of total billed charges · outpatientfrom % of charges | 1 | $59 | $59 | — | — | — | $59 – $59 |
| 18 | Baylor Scott & White Medical Center - Lakeway Lakeway, TX facility · percent of total billed charges · outpatientfrom % of charges | 2 | $62 | $62 | $3 | 4% | — | $59 – $65 |
| 19 | Baylor Scott & White Medical Center - Marble Falls Marble Falls, TX facility · percent of total billed charges · outpatientfrom % of charges | 1 | $59 | $59 | — | — | — | $59 – $59 |
| 20 | Baylor Scott & White Medical Center - Pflugerville Pflugerville, TX facility · percent of total billed charges · outpatientfrom % of charges | 1 | $59 | $59 | — | — | — | $59 – $59 |
| 21 | Baylor Scott & White Medical Center - Round Rock Round Rock, TX facility · percent of total billed charges · outpatientfrom % of charges | 1 | $59 | $59 | — | — | — | $59 – $59 |
| 22 | Baylor Scott & White Medical Center - Taylor Taylor, TX facility · percent of total billed charges · outpatientfrom % of charges | 1 | $59 | $59 | — | — | — | $59 – $59 |
| 23 | Baylor Scott & White Medical Center - Temple Temple, TX facility · percent of total billed charges · outpatientfrom % of charges | 1 | $59 | $59 | — | — | — | $59 – $59 |
| 24 | Berger Hospital Circleville, OH fee schedule · outpatient | 1 | $10 | $10 | $8 | 82% | — | $2 – $18 |
| 25 | Bethesda Hospital Inc. Lebanon, OH facility · fee schedule · outpatient | 1 | $12 | $12 | $10 | 82% | — | $2 – $22 |
← Payers reporting HCPCS E1701 · Snapshot 20261112T124536Z-e251e855