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
IMPACT TOOTH REMOV SOFT TISS
Suffern, NY
See all hospitals reporting HCPCS D7220 →Price type
Good Samaritan Hospital’s median price of $851 is 27% below the median hospital's median price ($1.2k), higher than 36% of the 630 hospitals reporting HCPCS D7220. The highlighted bar is where this hospital falls; shaded is the middle 50% of hospitals.
Negotiated rates from the hospital’s own file: 4 payers, 4 plan rates. A facility fee, a professional fee, a per diem and a case rate are different bills, so each is listed on its own. Open a payer to see it across hospitals.
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| # | |||||||
|---|---|---|---|---|---|---|---|
| 1 | Medicare medicare facility · fee schedule · outpatient | $807 | $807 | — | — | — | $807 – $807 |
| 2 | Molina affinity by molina mcr facility · fee schedule · outpatient | $843 | $843 | — | — | — | $843 – $843 |
| 3 | Cigna cigna ppo facility · case rate · outpatient | $5.9k | $5.9k | — | — | — | $5.9k – $5.9k |
| 4 | Tricare tricare facility · fee schedule · outpatient | $6.2k | $6.2k | — | — | — | $6.2k – $6.2k |
Last updated: Jun 29, 2026
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