Removal of bilateral space maintainers

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

REMOVE BILAT SPACE MAINTAIN

Payers reporting HCPCS D1525

Payer pricing summary

Low

$100

Average

$530

Median

$509

High

$1.3k

Payer rate distribution

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#
1	Humana fee schedule · outpatient · +2 other terms	33	$1.5k	$1.8k	$367	20%	—	$152 – $2.1k
2	Blue Cross Blue Shield fee schedule · outpatient · +3 other terms	9	$304	$528	$656	124%	—	$152 – $2.6k
3	Medicaid fee schedule · outpatient	7	$912	$912	—	—	—	$912 – $912
4	Anthem facility · fee schedule · outpatient	6	$320	$400	$299	75%	—	$60 – $1.0k
5	Aetna fee schedule · outpatient · +3 other terms	5	$1.1k	$937	$510	54%	—	$152 – $1.7k
6	Kaiser fee schedule · outpatient · +2 other terms	4	$556	$546	$299	55%	—	$152 – $912
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	4	$730	$730	$64	9%	—	$638 – $821
9	Wellmark facility · case rate · outpatient	3	$328	$288	$91	32%	—	$134 – $362
10	First Health percent of total billed charges · outpatientfrom % of charges	2	$739	$739	$9	1%	—	$730 – $748
11	UnitedHealthcare fee schedule · outpatient · +3 other terms	2	$152	$152	—	—	—	$152 – $152
12	Aetna Better Health facility · case rate · outpatient	1	$100	$100	$1	1%	—	$99 – $100
13	Amerihealth Caritas facility · case rate · outpatient	1	$103	$103	—	—	—	$103 – $103
14	Bcbs Tx percent of total billed charges · outpatientfrom % of charges	1	$197	$197	$22	11%	—	$175 – $219
15	Cigna facility · fee schedule · outpatient · +1 other terms	1	$715	$715	—	—	—	$715 – $715
16	Healthpartners facility · fee schedule · outpatient	1	$715	$715	—	—	—	$715 – $715
17	Phcs percent of total billed charges · outpatientfrom % of charges	1	$821	$821	—	—	—	$821 – $821