Cavity medicament application per tooth

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

Caries med app per tooth

Payers reporting HCPCS D1355

Payer pricing summary

Low

Average

$215

Median

$114

High

$1.0k

Payer rate distribution

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#
1	Molina facility · case rate · outpatient · +5 other terms	29	$642	$540	$477	88%	—	$74 – $1.6k
2	Aetna fee schedule · outpatient · +4 other terms	20	$79	$143	$136	95%	—	$51 – $676
3	Blue Cross Blue Shield facility · fee schedule · outpatient · +5 other terms	20	$98	$113	$80	71%	—	$60 – $352
4	UnitedHealthcare facility · case rate · outpatient · +6 other terms	18	$899	$820	$432	53%	—	$84 – $1.6k
5	Anthem facility · case rate · outpatient · +5 other terms	16	$935	$1.0k	$239	23%	—	$623 – $1.6k
6	Caresource facility · case rate · outpatient · +1 other terms	15	$934	$1.0k	$230	23%	—	$623 – $1.6k
7	Optum facility · case rate · outpatient · +1 other terms	13	$829	$815	$369	45%	—	$82 – $1.4k
8	Cigna professional · fee schedule · outpatient · +1 other terms	10	$64	$66	$2	4%	—	$64 – $69
9	Humana facility · case rate · outpatient · +2 other terms	8	$86	$89	$4	5%	—	$86 – $95
10	Aetna Better Health facility · case rate · outpatient	7	$103	$103	$1	1%	—	$99 – $103
11	Amerihealth Caritas facility · case rate · outpatient · +1 other terms	7	$95	$96	$3	3%	—	$95 – $103
12	Medica fee schedule · outpatient · +2 other terms	3	$116	$116	—	—	—	$116 – $116
13	Wellmark facility · case rate · outpatient	3	$328	$288	$91	32%	—	$134 – $362
14	Medicaid facility · case rate · outpatient	2	$86	$86	—	—	—	$86 – $86
15	Bcbs Id professional · fee schedule · outpatient	1	$1	$1	—	—	—	$1 – $1
16	Bcbs Mn fee schedule · outpatient	1	$61	$61	—	—	—	$61 – $61
17	Bcbs Nv fee schedule · outpatient	1	$81	$81	—	—	—	$81 – $81
18	Bcbs Vt professional · fee schedule · outpatient	1	$121	$121	—	—	—	$121 – $121
19	Highmark fee schedule · outpatient	1	$107	$107	$45	42%	—	$76 – $170
20	Regence facility · fee schedule · outpatient	1	$142	$142	—	—	—	$142 – $142
21	Ucare facility · fee schedule · outpatient	1	$16	$16	—	—	—	$16 – $16
22	WellCare facility · case rate · outpatient	1	$86	$86	—	—	—	$86 – $86