Metro Area and Rochester | Outstate Area | |||||||||||
CODE | Procedure | Mean | 95%tile | 75%tile | 5%tile | Range of Certainty* | Mean | 95%tile | 75%tile | 5%tile | Range of Certainty+ | |
0120 | Periodic Exam | $46 | $53 | $48 | $39 | 1% | $39 | $45 | $42 | $30 | 2% | |
0140 | Emergency Exam | $65 | $82 | $71 | $45 | 3% | $54 | $69 | $60 | $36 | 3% | |
0150 | Comprehensive Exam | $71 | $88 | $75 | $56 | 2% | $58 | $79 | $63 | $42 | 3% | |
1110 | Adult Prophy | $85 | $95 | $89 | $74 | 1% | $73 | $84 | $78 | $59 | 2% | |
1120 | Child Prophy | $60 | $67 | $63 | $50 | 1% | $50 | $61 | $55 | $38 | 2% | |
0220 | PA 1st Film | $27 | $32 | $29 | $21 | 3% | $23 | $29 | $26 | $17 | 2% | |
0272 | 2 Bitewings | $43 | $49 | $45 | $35 | 2% | $37 | $43 | $39 | $27 | 2% | |
0274 | 4 Bitewings | $55 | $62 | $59 | $47 | 1% | $49 | $58 | $52 | $38 | 2% | |
0210 | FMX | $121 | $140 | $129 | $99 | 2% | $108 | $139 | $115 | $82 | 2% | |
0330 | Panoramic Film | $109 | $126 | $114 | $95 | 2% | $95 | $114 | $101 | $78 | 2% | |
1203 | Child Fluoride | $38 | $44 | $40 | $30 | 2% | $31 | $38 | $34 | $22 | 3% | |
1204 | Adult Fluoride | $37 | $45 | $40 | $28 | 3% | $31 | $40 | $35 | $22 | 3% | |
1206 | Fluoride Varnish | $38 | $48 | $41 | $28 | 3% | $31 | $48 | $41 | $28 | 3% | |
1351 | Sealant (EACH) | $48 | $55 | $51 | $40 | 2% | $41 | $49 | $45 | $30 | 5% | |
Amalgams (Permanent) | ||||||||||||
2140 | 1 Surface | $119 | $150 | $127 | $97 | 2% | $101 | $131 | $110 | $74 | 3% | |
2150 | 2 Surfaces | $153 | $190 | $160 | $129 | 3% | $128 | $163 | $138 | $91 | 3% | |
2160 | 3 Surfaces | $188 | $239 | $198 | $155 | 3% | $156 | $203 | $170 | $109 | 3% | |
2161 | 4 Surfaces | $236 | $318 | $254 | $188 | 3% | $192 | $250 | $209 | $130 | 3% | |
Anterior Composites: | ||||||||||||
2330 | 1 Surface | $147 | $166 | $154 | $121 | 1% | $121 | $148 | $130 | $86 | 2% | |
2331 | 2 Surfaces | $195 | $226 | $208 | $159 | 2% | $152 | $188 | $165 | $105 | 2%td> | |
2332 | 3 Surfaces | $241 | $285 | $260 | $191 | 2% | $186 | $232 | $201 | $137 | 2% | |
2335 | Resin involving incisal Angle Class IV | $285 | $349 | $304 | $226 | 2% | $221 | $276 | $241 | $161 | 3% | |
Posterior Composites: | ||||||||||||
2391 | 1 Surface | $161 | $187 | $170 | $138 | 1% | $132 | $160 | $142 | $97 | 2% | |
2392 | 2 Surfaces | $229 | $266 | $242 | $189 | 2% | $181 | $226 | $197 | $130 | 2% | |
2393 | 3 Surfaces | $285 | $330 | $300 | $229 | 2% | $225 | $284 | $247 | $160 | 2% | |
2394 | 4 Surfaces | $332 | $392 | $351 | $265 | 2% | $264 | $337 | $290 | $185 | 3% | |
2630 | Porcelain inlay | $944 | $1,162 | $1,027 | $690 | 3% | $817 | $1,015 | $891 | $584 | 4% | |
2643 | Porcelain/Ceramic Onlay | $995 | $1,198 | $1,075 | $800 | 3% | $861 | $1,048 | $917 | $667 | 3% | |
2652 | Composite inlay | $868 | $1,103 | $986 | $581 | 4% | $755 | $1,000 | $862 | $471 | 5% | |
Crowns: | ||||||||||||
2740 | Ceramic Crown | $1,079 | $1,279 | $1,149 | $922 | 2% | $910 | $1,055 | $962 | $756 | 2% | |
2750 | Porcelain fused to high noble | $1,018 | $1,172 | $1,062 | $871 | 1% | $877 | $1,009 | $937 | $727 | 2% | |
2751 | Porcelain to predom base metal | $972 | $1,091 | $1,020 | $825 | 2% | $842 | $986 | $899 | $688 | 2% | |
2752 | Porcelain to noble | $995 | $1,166 | $1,036 | $856 | 2% | $855 | $987 | $912 | $695 | 2% | |
2790 | Full cast high noble | $1,027 | $1,200 | $1,078 | $884 | 1% | $874 | $1,007 | $936 | $709 | 2% | |
2791 | Full cast predom base | $968 | $1,106 | $1,009 | $831 | 2% | $831 | $986 | $889 | $660 | 2% | |
2931 | Stainless Steel | $337 | $444 | $369 | $224 | 3% | $266 | $362 | $296 | $186 | 4% | |
2950 | Crown Build-up | $254 | $312 | $275 | $189 | 3% | $202 | $264 | $226 | $128 | 3% | |
2960 | Labial Veneer, laminate | $598 | $987 | $651 | $315 | 6% | $482 | $842 | $542 | $249 | 6% | |
2962 | Labial Veneer , porcelain | $1,066 | $1,403 | $1,135 | $850 | 2% | $861 | $1,085 | $931 | $644 | 3% | |
Endodontics: | ||||||||||||
3221 | Open and Drain | $189 | $277 | $213 | $113 | 5% | $145 | $237 | $167 | $80 | 6% | |
3310 | 1 Canal | $676 | $785 | $720 | $549 | 2% | $559 | $691 | $610 | $408 | 2% | |
3320 | 2 Canals | $795 | $900 | $837 | $690 | 1% | $662 | $802 | $712 | $481 | 2% | |
3330 | 3 Canals | $958 | $1,095 | $1,000 | $833 | 1% | $816 | $977 | $884 | $624 | 2% | |
4341 | Four or more Root Planing | $257 | $305 | $275 | $207 | 3% | $214 | $265 | $235 | $147 | 5% | |
4342 | Root Planing (1-3) | $177 | $234 | $205 | $107 | 4% | $142 | $201 | $162 | $83 | 4% | |
4355 | Debridement | $198 | $270 | $225 | $129 | 5% | $159 | $217 | $177 | $101 | 3% | |
4381 | Arestin per Site | $57 | $154 | $68 | $27 | 10% | $56 | $140 | $65 | $30 | 11% | |
4381 | Atridox Per Application | $85 | $174 | $114 | $30 | 15% | $69 | $149 | $84 | $32 | 15% | |
4910 | Perio Maintenance | $136 | $160 | $147 | $105 | 2% | $111 | $139 | $124 | $78 | 3% | |
5120 | Lower Full Denture | $1,739 | $2,175 | $1,865 | $1,387 | 2% | $1,379 | $1,821 | $1,502 | $996 | 3% | |
5213 | Upper Partial | $1,793 | $2,177 | $1,932 | $1,404 | 2% | $1,455 | $1,853 | $1,580 | $1,030 | 3% | |
6010 | Surgical Placement of Implant | $1,956 | $2,367 | $2,131 | $1,230 | 6% | $1,578 | $2,074 | $1,800 | $847 | 9% | |
6056 | Prefabricated Abutment | $586 | $881 | $700 | $300 | 6% | $560 | $904 | $686 | $335 | 7% | |
6059 | Abutment Sup Crown Implant | $1,229 | $1,696 | $1,370 | $890 | 3% | $1,068 | $1,492 | $1,200 | $762 | 4% | |
6066 | Implant – Supp Crown-Porc to Metal | $1,280 | $1,806 | $1,459 | $904 | 4% | $1,139 | $1,600 | $1,299 | $827 | 4% | |
7140 | Simple Extraction | $157 | $192 | $170 | $124 | 3% | $126 | $164 | $138 | $95 | 3% | |
8090 | Invisalign | $4,999 | $6,183 | $5,509 | $3,633 | 5% | $4,723 | $5,331 | $5,000 | $3,813 | 4% | |
9110 | Palliative Treatment | $122 | $185 | $147 | $68 | 5% | $95 | $150 | $111 | $52 | 5% | |
9972 | Take Home Bleaching (Both Arches) | $300 | $460 | $354 | $175 | 5% | $280 | $462 | $350 | $150 | 5% | |
9999 | In Office Bleaching (Both Arches) | $483 | $689 | $585 | $229 | 6% | $493 | $840 | $540 | $259 | 13% | |
* 95% chance that the population mean is within plus or minus this percentage of the mean. | ||||||||||||
Metro Area is defined as the seven county metro area |
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