Bilateral fixed space maintainer

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

Fixed bilat space maintainer

Payers reporting HCPCS D1515

Payer pricing summary

Low

$43

Average

$450

Median

$392

High

$1.1k

Payer rate distribution

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#
1	Humana fee schedule · outpatient · +2 other terms	33	$1.3k	$1.5k	$299	20%	—	$152 – $1.7k
2	Blue Cross Blue Shield fee schedule · outpatient · +5 other terms	9	$304	$528	$656	124%	—	$152 – $2.6k
3	Medicaid fee schedule · outpatient	7	$966	$966	—	—	—	$966 – $966
4	Anthem facility · fee schedule · outpatient	6	$320	$362	$220	61%	—	$60 – $799
5	Aetna fee schedule · outpatient · +5 other terms	5	$932	$857	$489	57%	—	$152 – $1.7k
6	Kaiser fee schedule · outpatient · +2 other terms	4	$578	$567	$324	57%	—	$152 – $966
7	Molina facility · case rate · outpatient · +1 other terms	4	$134	$141	$33	23%	—	$103 – $194
8	MultiPlan percent of total billed charges · outpatientfrom % of charges · +2 other terms	4	$773	$773	$68	9%	—	$676 – $869
9	Wellmark facility · case rate · outpatient	3	$328	$288	$91	32%	—	$134 – $362
10	UnitedHealthcare fee schedule · outpatient · +3 other terms	2	$152	$152	—	—	—	$152 – $152
11	Aetna Better Health facility · case rate · outpatient	1	$100	$100	$1	1%	—	$99 – $100
12	Amerihealth Caritas facility · case rate · outpatient	1	$103	$103	—	—	—	$103 – $103
13	Bcbs Tx percent of total billed charges · outpatientfrom % of charges	1	$169	$169	$19	11%	—	$150 – $187
14	Cigna facility · fee schedule · outpatient · +1 other terms	1	$590	$590	—	—	—	$590 – $590
15	Devoted professional · percent of total billed charges · inpatientfrom % of charges · +1 other terms	1	$43	$43	—	—	—	$43 – $43
16	First Health professional · fee schedule · inpatient · +4 other terms	1	$66	$66	—	—	—	$66 – $66
17	Healthpartners facility · fee schedule · outpatient	1	$590	$590	—	—	—	$590 – $590
18	Phcs percent of total billed charges · outpatientfrom % of charges	1	$869	$869	—	—	—	$869 – $869