Topical fluoride varnish application

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.

Model: claude-haiku-5-5
Provider: anthropic
API: message_batches
Reasoning effort: low
Max output tokens: 4096
Prompt version (hash): 444523875572
Generated: October 20, 2026

Original text from hospital filings

HC Topical Fluoride Varnish

Payers reporting HCPCS D1206

Payer pricing summary

Low

Average

$1.2k

Median

$56

High

$22k

Payer rate distribution

Filter by billing methodology

Filter by billing class

#
1	Humana fee schedule · outpatient · +12 other terms	71	$161	$127	$76	60%	—	$24 – $219
2	UnitedHealthcare fee schedule · outpatient · +20 other terms	31	$35	$49	$47	95%	—	$2 – $230
3	Blue Cross Blue Shield facility · fee schedule · outpatient · +17 other terms	29	$62	$588	$2.8k	484%	—	$15 – $22k
4	Molina facility · case rate · outpatient · +9 other terms	28	$751	$555	$478	86%	—	$74 – $1.6k
5	Aetna fee schedule · outpatient · +14 other terms	26	$32	$64	$101	158%	—	$12 – $619
6	Anthem professional · fee schedule · outpatient · +9 other terms	17	$28	$55	$45	82%	—	$20 – $176
7	Caresource facility · case rate · outpatient · +3 other terms	15	$934	$1.0k	$230	23%	—	$623 – $1.6k
8	Baylor Scott White Health Plan facility · percent of total billed charges · outpatientfrom % of charges	14	$11	$11	$1	8%	—	$10 – $12
9	Optum facility · case rate · outpatient · +4 other terms	13	$829	$815	$369	45%	—	$82 – $1.4k
10	Superior Healthplan facility · percent of total billed charges · outpatientfrom % of charges	13	$3	$3	$1	32%	—	$2 – $6
11	Highmark fee schedule · outpatient · +4 other terms	11	$25	$27	$15	55%	—	$25 – $170
12	Cigna professional · fee schedule · outpatient · +13 other terms	10	$13	$14	$1	10%	—	$13 – $17
13	Clover facility · percent of total billed charges · outpatientfrom % of charges	10	$14	$14	—	—	—	$14 – $14
14	Medcost percent of total billed charges · bothfrom % of charges · +2 other terms	9	$32	$32	$2	6%	—	$30 – $34
15	Medicaid fee schedule · outpatient · +6 other terms	9	$84	$70	$18	26%	—	$39 – $84
16	Tricare fee schedule · both · +4 other terms	9	$53	$53	—	—	—	$53 – $53
17	Aetna Better Health facility · case rate · outpatient · +2 other terms	7	$103	$103	$1	1%	—	$99 – $103
18	Amerihealth Caritas facility · case rate · outpatient · +3 other terms	7	$95	$96	$3	3%	—	$95 – $103
19	Medica fee schedule · outpatient · +3 other terms	5	$24	$20	$4	21%	—	$16 – $24
20	Kaiser fee schedule · outpatient · +3 other terms	4	$219	$214	$156	73%	—	$39 – $523
21	Oscar professional · percent of total billed charges · outpatientfrom % of charges · +1 other terms	4	$13	$13	—	—	—	$13 – $13
22	Phcs facility · percent of total billed charges · outpatientfrom % of charges · +2 other terms	3	$72	$7.4k	$10.3k	140%	—	$72 – $21.9k
23	Wellmark facility · case rate · outpatient · +1 other terms	3	$328	$288	$91	32%	—	$134 – $362
24	Excellus fee schedule · outpatient · +4 other terms	2	$20	$21	$18	85%	—	$5 – $44
25	Sanford Health Plan professional · percent of total billed charges · bothfrom % of charges	2	$37	$37	—	—	—	$37 – $37

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