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

TOPICAL APP OF FLUORIDE

Payers reporting HCPCS D1208

Payer pricing summary

Low

$10

Average

$1.7k

Median

$291

High

$25.0k

Payer rate distribution

Filter by billing methodology

Filter by billing class

#
1	Molina facility · case rate · outpatient · +9 other terms	29	$642	$540	$477	88%	—	$74 – $1.6k
2	UnitedHealthcare professional · fee schedule · outpatient · +14 other terms	27	$18	$24	$8	33%	—	$11 – $41
3	Aetna fee schedule · outpatient · +13 other terms	25	$26	$71	$119	167%	—	$7 – $619
4	Blue Cross Blue Shield fee schedule · outpatient · +11 other terms	22	$32	$245	$801	327%	—	$0 – $4.4k
5	Anthem facility · case rate · outpatient · +5 other terms	15	$916	$1.0k	$235	23%	—	$623 – $1.6k
6	Caresource facility · case rate · outpatient · +4 other terms	15	$934	$1.0k	$230	23%	—	$623 – $1.6k
7	MultiPlan facility · percent of total billed charges · outpatientfrom % of charges · +6 other terms	15	$52	$52	$7	13%	—	$31 – $63
8	Optum facility · case rate · outpatient · +4 other terms	13	$829	$815	$369	45%	—	$82 – $1.4k
9	Humana fee schedule · outpatient · +11 other terms	12	$44	$74	$68	92%	—	$13 – $194
10	Cigna professional · fee schedule · outpatient · +9 other terms	10	$10	$10	$1	8%	—	$9 – $10
11	Clover facility · percent of total billed charges · outpatientfrom % of charges	10	$11	$11	$0	0%	—	$11 – $11
12	Highmark fee schedule · outpatient · +5 other terms	10	$25	$25	—	—	—	$25 – $25
13	Medcost percent of total billed charges · bothfrom % of charges	8	$48	$48	$3	6%	—	$45 – $51
14	Aetna Better Health facility · case rate · outpatient · +3 other terms	7	$103	$103	$1	1%	—	$99 – $103
15	Amerihealth Caritas facility · case rate · outpatient · +3 other terms	7	$95	$96	$3	3%	—	$95 – $103
16	Medicaid fee schedule · outpatient · +4 other terms	7	$157	$157	—	—	—	$157 – $157
17	Medica fee schedule · outpatient · +3 other terms	5	$19	$17	$4	24%	—	$12 – $22
18	Tricare facility · fee schedule · outpatient · +3 other terms	5	$50k	$35.7k	$22.5k	63%	—	$84 – $50k
19	Kaiser fee schedule · outpatient · +2 other terms	4	$273	$263	$127	48%	—	$152 – $523
20	Oscar professional · percent of total billed charges · outpatientfrom % of charges	4	$10	$11	$3	24%	—	$8 – $13
21	Excellus fee schedule · outpatient · +4 other terms	3	$32	$35	$30	85%	—	$9 – $78
22	Wellmark facility · case rate · outpatient · +2 other terms	3	$328	$288	$91	32%	—	$134 – $362
23	Regence facility · fee schedule · outpatient	2	$339	$532	$257	48%	—	$18 – $660
24	Ambetter facility · other · outpatient	1	$1.0k	$1.0k	—	—	—	$1.0k – $1.0k
25	Bcbs Id professional · fee schedule · outpatient	1	$39	$39	—	—	—	$39 – $39

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