Dental spacer removal, both sides of upper jaw

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 fixed bilat maint max

Payers reporting HCPCS D1557

Payer pricing summary

Low

$22

Average

$209

Median

$97

High

$1.0k

Payer rate distribution

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#
1	Aetna fee schedule · outpatient · +7 other terms	30	$112	$264	$345	131%	—	$14 – $931
2	Molina facility · case rate · outpatient · +5 other terms	29	$642	$540	$477	88%	—	$74 – $1.6k
3	Blue Cross Blue Shield facility · fee schedule · outpatient · +6 other terms	20	$134	$149	$79	53%	—	$94 – $361
4	UnitedHealthcare professional · fee schedule · outpatient · +9 other terms	19	$39	$51	$18	36%	—	$25 – $90
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 · +2 other terms	13	$829	$815	$369	45%	—	$82 – $1.4k
8	Cigna professional · fee schedule · outpatient · +3 other terms	10	$23	$22	$2	8%	—	$19 – $23
9	Highmark fee schedule · outpatient	10	$1.1k	$830	$418	50%	—	$76 – $1.1k
10	Humana facility · case rate · outpatient · +3 other terms	8	$86	$89	$4	5%	—	$86 – $95
11	Aetna Better Health facility · case rate · outpatient	7	$103	$103	$1	1%	—	$99 – $103
12	Amerihealth Caritas facility · case rate · outpatient · +1 other terms	7	$95	$96	$3	3%	—	$95 – $103
13	Medicaid fee schedule · outpatient · +1 other terms	7	$100	$100	—	—	—	$100 – $100
14	Kaiser fee schedule · outpatient · +1 other terms	4	$250	$242	$146	60%	—	$100 – $523
15	MultiPlan percent of total billed charges · outpatientfrom % of charges · +3 other terms	4	$80	$80	$7	9%	—	$70 – $90
16	Oscar professional · percent of total billed charges · outpatientfrom % of charges	4	$42	$42	—	—	—	$42 – $42
17	Medica fee schedule · outpatient · +2 other terms	3	$42	$42	—	—	—	$42 – $42
18	Wellmark facility · case rate · outpatient	3	$328	$288	$91	32%	—	$134 – $362
19	First Health percent of total billed charges · outpatientfrom % of charges · +2 other terms	2	$81	$81	$1	1%	—	$80 – $82
20	Bcbs Id professional · fee schedule · outpatient	1	$58	$58	—	—	—	$58 – $58
21	Bcbs Mn fee schedule · outpatient	1	$96	$96	—	—	—	$96 – $96
22	Bcbs Nv fee schedule · outpatient	1	$22	$22	—	—	—	$22 – $22
23	Bcbs Vt professional · fee schedule · outpatient	1	$36	$36	—	—	—	$36 – $36
24	Phcs percent of total billed charges · outpatientfrom % of charges	1	$90	$90	—	—	—	$90 – $90
25	Regence facility · fee schedule · outpatient	1	$39	$39	—	—	—	$39 – $39

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