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
REPLC TTH&ACRLC MANDIBULAR
Ukiah, CA
See all hospitals reporting HCPCS D5671 →Price type
Ukiah Adventist Hospital’s median price of $756 is 28% above the median hospital's median price ($589), higher than 57% of the 239 hospitals reporting HCPCS D5671. The highlighted bar is where this hospital falls; shaded is the middle 50% of hospitals.
Negotiated rates from the hospital’s own file: 6 payers, 14 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 | Blue Cross Blue Shield blue shield mcr adv fee schedule · outpatient | $280 | $280 | — | — | — | $280 – $280 |
| 2 | Blue Cross Blue Shield tricare blue shield-all plans fee schedule · outpatient | $280 | $280 | — | — | — | $280 – $280 |
| 3 | Kaiser kaiser mcr adv fee schedule · outpatient | $280 | $280 | — | — | — | $280 – $280 |
| 4 | Blue Cross Blue Shield blue cross exchange case rate · outpatient | $434 | $434 | — | — | — | $434 – $434 |
| 5 | Blue Cross Blue Shield blue shield epn-all other plans percent of total billed charges · outpatientfrom % of charges | $434 | $434 | — | — | — | $434 – $434 |
| 6 | Blue Cross Blue Shield blue shield non-epn percent of total billed charges · outpatientfrom % of charges | $440 | $440 | — | — | — | $440 – $440 |
| 7 | Blue Cross Blue Shield blue cross mcs-all other plans case rate · outpatient | $482 | $482 | — | — | — | $482 – $482 |
| 8 | Blue Cross Blue Shield blue cross non-mcs case rate · outpatient | $482 | $482 | — | — | — | $482 – $482 |
| 9 | Aetna aetna-all plans percent of total billed charges · outpatientfrom % of charges | $756 | $756 | — | — | — | $756 – $756 |
| 10 | Cigna cigna-all plans percent of total billed charges · outpatientfrom % of charges | $889 | $889 | — | — | — | $889 – $889 |
| 11 | Kaiser kaiser-all other plans percent of total billed charges · outpatientfrom % of charges | $912 | $912 | — | — | — | $912 – $912 |
| 12 | MultiPlan phcs multiplan-all plans percent of total billed charges · outpatientfrom % of charges | $912 | $912 | — | — | — | $912 – $912 |
| 13 | Kaiser kaiser medi-cal fee schedule · outpatient | $1.1k | $1.1k | — | — | — | $1.1k – $1.1k |
| 14 | Medicaid medi-cal fee schedule · outpatient | $1.1k | $1.1k | — | — | — | $1.1k – $1.1k |
Last updated: May 24, 2026
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