Removal of 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

REMOVE FIX SPACE MAINTAINER

Payers reporting HCPCS D1555

Payer pricing summary

Low

$65

Average

$128

Median

$113

High

$288

Payer rate distribution

Filter by billing methodology

Filter by billing class

#
1	Humana fee schedule · outpatient · +2 other terms	35	$186	$211	$57	27%	—	$28 – $253
2	Blue Cross Blue Shield fee schedule · outpatient · +3 other terms	7	$280	$276	$98	35%	—	$152 – $403
3	Medicaid fee schedule · outpatient	7	$139	$139	—	—	—	$139 – $139
4	Anthem facility · fee schedule · outpatient · +1 other terms	6	$295	$251	$115	46%	—	$60 – $378
5	Aetna fee schedule · outpatient · +3 other terms	4	$145	$262	$206	79%	—	$139 – $619
6	Kaiser fee schedule · outpatient · +1 other terms	4	$266	$257	$133	52%	—	$139 – $523
7	Molina facility · case rate · outpatient · +2 other terms	4	$134	$141	$33	23%	—	$103 – $194
8	MultiPlan percent of total billed charges · outpatientfrom % of charges	4	$111	$111	$10	9%	—	$97 – $125
9	UnitedHealthcare fee schedule · outpatient · +4 other terms	3	$152	$77	$61	79%	—	$28 – $152
10	Wellmark facility · case rate · outpatient	3	$328	$288	$91	32%	—	$134 – $362
11	Amerihealth Caritas case rate · outpatient · +1 other terms	2	$95	$95	—	—	—	$95 – $95
12	First Health percent of total billed charges · outpatientfrom % of charges	2	$113	$113	$1	1%	—	$111 – $114
13	Aetna Better Health facility · case rate · outpatient	1	$100	$100	$1	1%	—	$99 – $100
14	Bcbs Tx percent of total billed charges · outpatientfrom % of charges	1	$65	$65	$8	12%	—	$57 – $72
15	Cigna facility · fee schedule · outpatient · +2 other terms	1	$88	$88	—	—	—	$88 – $88
16	Healthpartners facility · fee schedule · outpatient	1	$88	$88	—	—	—	$88 – $88
17	Phcs percent of total billed charges · outpatientfrom % of charges	1	$125	$125	—	—	—	$125 – $125