|
|
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 |
$48 |
$58 |
$50 |
$40 |
2% |
|
$41 |
$49 |
$44 |
$32 |
2% |
| 0140 |
Emergency Exam |
$68 |
$84 |
$74 |
$49 |
3% |
|
$56 |
$72 |
$64 |
$38 |
3% |
| 0150 |
Comprehensive Exam |
$74 |
$100 |
$78 |
$55 |
3% |
|
$61 |
$81 |
$67 |
$45 |
3% |
| 1110 |
Adult Prophy |
$88 |
$99 |
$93 |
$77 |
1% |
|
$75 |
$89 |
$81 |
$61 |
2% |
| 1120 |
Child Prophy |
$62 |
$71 |
$65 |
$51 |
2% |
|
$52 |
$63 |
$56 |
$42 |
2% |
| 0220 |
PA 1st Film |
$28 |
$33 |
$30 |
$22 |
2% |
|
$24 |
$30 |
$27 |
$18 |
2% |
| 0272 |
2 Bitewings |
$45 |
$52 |
$48 |
$36 |
2% |
|
$38 |
$47 |
$41 |
$29 |
2% |
| 0274 |
4 Bitewings |
$57 |
$68 |
$61 |
$48 |
2% |
|
$52 |
$62 |
$55 |
$42 |
2% |
| 0210 |
FMX |
$127 |
$149 |
$134 |
$101 |
2% |
|
$112 |
$141 |
$120 |
$92 |
2% |
| 0330 |
Panoramic Film |
$114 |
$136 |
$119 |
$95 |
3% |
|
$99 |
$117 |
$105 |
$83 |
2% |
| 1203 |
Child Fluoride |
$39 |
$48 |
$42 |
$30 |
2% |
|
$32 |
$40 |
$36 |
$21 |
3% |
| 1204 |
Adult Fluoride |
$38 |
$47 |
$41 |
$25 |
3% |
|
$32 |
$41 |
$36 |
$22 |
3% |
| 1206 |
Fluoride Varnish |
$39 |
$50 |
$42 |
$29 |
3% |
|
$32 |
$50 |
$42 |
$29 |
3% |
| 1351 |
Sealant (each) |
$50 |
$59 |
$53 |
$42 |
3% |
|
$42 |
$51 |
$45 |
$35 |
2% |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Amalgams (Permanent): |
|
|
|
|
|
|
|
|
|
|
|
| 2140 |
1 Surface |
$125 |
$166 |
$130 |
$98 |
3% |
|
$106 |
$133 |
$114 |
$82 |
2% |
| 2150 |
2 Surfaces |
$160 |
$214 |
$166 |
$130 |
3% |
|
$134 |
$174 |
$143 |
$105 |
2% |
| 2160 |
3 Surfaces |
$197 |
$258 |
$205 |
$157 |
3% |
|
$163 |
$204 |
$175 |
$127 |
2% |
| 2161 |
4 Surfaces |
$247 |
$330 |
$260 |
$199 |
3% |
|
$200 |
$262 |
$216 |
$148 |
8% |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Anterior Composites: |
|
|
|
|
|
|
|
|
|
|
|
| 2330 |
1 Surface |
$152 |
$174 |
$160 |
$129 |
1% |
|
$126 |
$154 |
$134 |
$97 |
2% |
| 2331 |
2 Surfaces |
$202 |
$234 |
$213 |
$167 |
2% |
|
$159 |
$200 |
$171 |
$123 |
2% |
| 2332 |
3 Surfaces |
$250 |
$293 |
$265 |
$199 |
2% |
|
$194 |
$242 |
$208 |
$145 |
2% |
| 2335 |
Resin involving incisal Angle Class IV |
$293 |
$354 |
$310 |
$231 |
2% |
|
$234 |
$302 |
$255 |
$180 |
3% |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Posterior Composites: |
|
|
|
|
|
|
|
|
|
|
|
| 2391 |
1 Surface |
$166 |
$190 |
$175 |
$137 |
2% |
|
$139 |
$165 |
$150 |
$111 |
2% |
| 2392 |
2 Surfaces |
$238 |
$274 |
$252 |
$192 |
2% |
|
$189 |
$229 |
$205 |
$144 |
2% |
| 2393 |
3 Surfaces |
$296 |
$335 |
$310 |
$244 |
2% |
|
$235 |
$285 |
$255 |
$174 |
2% |
| 2394 |
4 Surfaces |
$343 |
$398 |
$361 |
$275 |
2% |
|
$276 |
$348 |
$300 |
$195 |
3% |
| 2630 |
Porcelain inlay |
$970 |
$1,196 |
$1,072 |
$704 |
3% |
|
$833 |
$1,056 |
$921 |
$535 |
4% |
| 2643 |
Porcelain/Ceramic Onlay |
$1,021 |
$1,200 |
$1,110 |
$795 |
2% |
|
$868 |
$1,050 |
$945 |
$594 |
3% |
| 2652 |
Composite inlay |
$917 |
$1,144 |
$1,025 |
$595 |
4% |
|
$735 |
$987 |
$862 |
$461 |
5% |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Crowns: |
|
|
|
|
|
|
|
|
|
|
|
| 2740 |
Ceramic Crown |
$1,118 |
$1,300 |
$1,195 |
$950 |
2% |
|
$934 |
$1,083 |
$992 |
$793 |
2% |
| 2750 |
Porcelain fused to high noble |
$1,063 |
$1,242 |
$1,103 |
$899 |
1% |
|
$906 |
$1,050 |
$964 |
$766 |
2% |
| 2751 |
Porcelain to predom base metal |
$1,011 |
$1,198 |
$1,056 |
$815 |
2% |
|
$866 |
$1,011 |
$932 |
$739 |
2% |
| 2752 |
Porcelain to noble |
$1,041 |
$1,238 |
$1,099 |
$874 |
2% |
|
$881 |
$1,024 |
$940 |
$748 |
2% |
| 2790 |
Full cast high noble |
$1,078 |
$1,267 |
$1,122 |
$906 |
1% |
|
$921 |
$1,089 |
$975 |
$775 |
2% |
| 2791 |
Full cast predom base |
$1,000 |
$1,197 |
$1,055 |
$819 |
2% |
|
$859 |
$1,026 |
$931 |
$701 |
2% |
| 2931 |
Stainless Steel |
$349 |
$459 |
$385 |
$226 |
5% |
|
$277 |
$372 |
$303 |
$194 |
5% |
| 2950 |
Crown Build-up |
$262 |
$320 |
$285 |
$196 |
2% |
|
$209 |
$270 |
$231 |
$131 |
5% |
| 2960 |
Labial Veneer (LAMINATE) |
$626 |
$1,088 |
$690 |
$340 |
5% |
|
$491 |
$875 |
$568 |
$249 |
6% |
| 2962 |
Labial Veneer (PORCELAIN) |
$1,120 |
$1,463 |
$1,200 |
$858 |
2% |
|
$896 |
$1,084 |
$975 |
$692 |
2% |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Endodontics: |
|
|
|
|
|
|
|
|
|
|
|
| 3221 |
Open and Drain |
$205 |
$303 |
$231 |
$127 |
6% |
|
$149 |
$221 |
$172 |
$87 |
6% |
| 3310 |
1 Canal |
$707 |
$823 |
$750 |
$577 |
2% |
|
$582 |
$698 |
$630 |
$466 |
2% |
| 3320 |
2 Canals |
$826 |
$934 |
$875 |
$701 |
2% |
|
$686 |
$823 |
$740 |
$536 |
2% |
| 3330 |
3 Canals |
$995 |
$1,116 |
$1,048 |
$859 |
1% |
|
$841 |
$984 |
$900 |
$685 |
2% |
| 4341 |
Four or more Root Planing |
$268 |
$321 |
$285 |
$210 |
5% |
|
$223 |
$291 |
$241 |
$164 |
5% |
| 4342 |
Root Planing (1-3) |
$183 |
$245 |
$210 |
$112 |
4% |
|
$148 |
$210 |
$170 |
$83 |
4% |
| 4355 |
Debridement |
$210 |
$292 |
$235 |
$135 |
4% |
|
$163 |
$225 |
$180 |
$96 |
4% |
| 4381 |
Arestin per Site |
$59 |
$143 |
$68 |
$27 |
10% |
|
$56 |
$129 |
$65 |
$30 |
9% |
| 4381 |
Atridox Per Application |
$70 |
$171 |
$83 |
$30 |
16% |
|
$65 |
$151 |
$79 |
$30 |
12% |
| 4910 |
Perio Maintenance |
$141 |
$168 |
$152 |
$111 |
2% |
|
$116 |
$144 |
$127 |
$87 |
2% |
| 5120 |
LOWER Full Denture |
$1,799 |
$2,194 |
$1,900 |
$1,364 |
2% |
|
$1,442 |
$1,826 |
$1,564 |
$1,100 |
2% |
| 5213 |
UPPER Partial |
$1,887 |
$2,310 |
$1,989 |
$1,505 |
2% |
|
$1,526 |
$1,875 |
$1,650 |
$1,150 |
2% |
| 6010 |
Surgical Placement of Implant |
$1,904 |
$2,325 |
$2,131 |
$1,080 |
6% |
|
$1,694 |
$2,157 |
$1,919 |
$771 |
7% |
| 6056 |
Prefabricated Abutment |
$642 |
$1,097 |
$778 |
$311 |
6% |
|
$604 |
$978 |
$748 |
$327 |
6% |
| 6059 |
Abutment Sup Crown Implant |
$1,252 |
$1,687 |
$1,390 |
$916 |
3% |
|
$1,083 |
$1,500 |
$1,202 |
$800 |
4% |
| 6066 |
Implant – Supp Crown-Porc to Metal |
$1,326 |
$1,888 |
$1,499 |
$966 |
4% |
|
$1,177 |
$1,654 |
$1,305 |
$845 |
4% |
| 7140 |
Simple Extraction |
$164 |
$200 |
$176 |
$123 |
3% |
|
$134 |
$168 |
$146 |
$103 |
2% |
| 8090 |
Invisalign |
$4,999 |
$6,067 |
$5,469 |
$3,955 |
4% |
|
$4,917 |
$5,865 |
$5,200 |
$3,853 |
3% |
| 9110 |
Palliative Treatment |
$128 |
$191 |
$150 |
$66 |
6% |
|
$103 |
$162 |
$118 |
$54 |
5% |
| 9972 |
Take Home Bleaching (Both Arches) |
$298 |
$442 |
$360 |
$155 |
5% |
|
$265 |
$500 |
$313 |
$100 |
6% |
| 9999 |
In Office Bleaching (Both Arches) |
$493 |
$719 |
$591 |
$236 |
6% |
|
$437 |
$658 |
$517 |
$240 |
26% |
|
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| * 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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