Gingival irrigation per quadrant

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

Gingival irrigation per quad

Payers reporting HCPCS D4921

Payer pricing summary

Low

$33

Average

$173

Median

$157

High

$342

Payer rate distribution

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#
1	Aetna fee schedule · outpatient · +6 other terms	273	$143	$159	$71	45%	—	$6 – $551
2	UnitedHealthcare fee schedule · outpatient · +7 other terms	164	$138	$188	$244	130%	—	$17 – $3.8k
3	Blue Cross Blue Shield fee schedule · outpatient · +4 other terms	161	$143	$221	$150	68%	—	$20 – $969
4	Humana fee schedule · outpatient · +4 other terms	153	$131	$137	$43	31%	—	$22 – $385
5	Cigna fee schedule · outpatient · +4 other terms	99	$138	$174	$85	48%	—	$120 – $436
6	Molina fee schedule · outpatient · +5 other terms	86	$157	$180	$60	33%	—	$97 – $361
7	WellCare fee schedule · outpatient · +3 other terms	77	$134	$161	$56	35%	—	$121 – $302
8	Devoted fee schedule · outpatient · +2 other terms	47	$139	$136	$8	6%	—	$124 – $149
9	Ambetter facility · fee schedule · outpatient · +3 other terms	41	$231	$233	$49	21%	—	$125 – $310
10	Anthem facility · case rate · outpatient · +5 other terms	36	$152	$239	$177	74%	—	$36 – $593
11	Oscar fee schedule · outpatient · +3 other terms	36	$273	$259	$55	21%	—	$160 – $380
12	Kaiser fee schedule · outpatient · +2 other terms	26	$285	$268	$123	46%	—	$135 – $576
13	Bcbs Tx fee schedule · outpatient	23	$127	$127	$4	3%	—	$121 – $133
14	Optum fee schedule · outpatient · +3 other terms	23	$139	$205	$108	53%	—	$121 – $491
15	Clover fee schedule · outpatient · +2 other terms	21	$141	$138	$8	6%	—	$120 – $152
16	Caresource facility · case rate · outpatient · +3 other terms	16	$56	$70	$39	56%	—	$36 – $205
17	Regence facility · case rate · outpatient · +2 other terms	16	$139	$166	$76	46%	—	$119 – $411
18	MultiPlan fee schedule · outpatient · +4 other terms	14	$212	$212	—	—	—	$212 – $212
19	First Health fee schedule · outpatient · +2 other terms	13	$139	$159	$48	30%	—	$139 – $271
20	Highmark fee schedule · outpatient · +3 other terms	13	$136	$133	$68	51%	—	$58 – $315
21	Bcbs Nj fee schedule · outpatient	12	$145	$305	$205	67%	—	$141 – $623
22	Tricare fee schedule · outpatient · +2 other terms	11	$121	$124	$3	3%	—	$121 – $129
23	Medical Mutual fee schedule · outpatient · +2 other terms	10	$353	$323	$110	34%	—	$116 – $559
24	Aetna Better Health facility · case rate · outpatient · +1 other terms	7	$211	$208	$9	4%	—	$175 – $211
25	Amerihealth Caritas facility · case rate · outpatient · +3 other terms	7	$193	$196	$6	3%	—	$193 – $211

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