Removal of fixed orthodontic appliance

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

REMOVAL OF FIXED ORTHODONTIC APPLIANCE(S) - OTHER THAN AT CONCLUSION OF TREATMENT

Payers reporting HCPCS D8695

Payer pricing summary

Low

$47

Average

$197

Median

$176

High

$503

Payer rate distribution

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#
1	Ambetter facility · percent of total billed charges · outpatientfrom % of charges	1	$47	$47	—	—	1–10	$47 – $47
2	Molina facility · case rate · outpatient · +5 other terms	29	$89	$230	$380	165%	—	$37 – $1.7k
3	Aetna fee schedule · outpatient · +7 other terms	20	$94	$188	$168	89%	—	$59 – $780
4	Blue Cross Blue Shield facility · fee schedule · outpatient · +5 other terms	20	$478	$351	$174	50%	—	$111 – $505
5	UnitedHealthcare professional · fee schedule · outpatient · +9 other terms	19	$156	$206	$72	35%	—	$100 – $364
6	Anthem facility · case rate · outpatient · +6 other terms	15	$52	$57	$13	23%	—	$36 – $89
7	Caresource facility · case rate · outpatient · +2 other terms	15	$53	$57	$13	23%	—	$36 – $90
8	Optum facility · case rate · outpatient · +2 other terms	13	$50	$71	$42	59%	—	$44 – $167
9	Highmark fee schedule · outpatient · +2 other terms	11	$233	$231	$17	7%	—	$107 – $242
10	Cigna professional · fee schedule · outpatient · +3 other terms	10	$92	$87	$6	7%	—	$79 – $92
11	Humana facility · case rate · outpatient · +4 other terms	8	$176	$182	$9	5%	—	$176 – $193
12	Aetna Better Health facility · case rate · outpatient · +1 other terms	7	$211	$208	$9	4%	—	$175 – $211
13	Amerihealth Caritas facility · case rate · outpatient · +1 other terms	7	$193	$196	$6	3%	—	$193 – $211
14	MultiPlan professional · percent of total billed charges · outpatientfrom % of charges · +3 other terms	4	$270	$270	—	—	—	$270 – $270
15	Oscar professional · percent of total billed charges · outpatientfrom % of charges	4	$76	$76	—	—	—	$76 – $76
16	Medica fee schedule · outpatient · +2 other terms	3	$165	$165	—	—	—	$165 – $165
17	Wellmark facility · case rate · outpatient	3	$573	$503	$159	32%	—	$234 – $633
18	Medicaid facility · case rate · outpatient	2	$176	$176	—	—	—	$176 – $176
19	Bcbs Id professional · fee schedule · outpatient	1	$174	$174	—	—	—	$174 – $174
20	Bcbs Mn fee schedule · outpatient	1	$489	$489	—	—	—	$489 – $489
21	Bcbs Nv fee schedule · outpatient	1	$93	$93	—	—	—	$93 – $93
22	Bcbs Vt professional · fee schedule · outpatient · +1 other terms	1	$144	$144	—	—	—	$144 – $144
23	Excellus facility · percent of total billed charges · outpatientfrom % of charges	1	$81	$81	$41	51%	—	$39 – $138
24	First Health facility · percent of total billed charges · inpatientfrom % of charges · +1 other terms	1	$225	$225	—	—	—	$225 – $225
25	Regence facility · fee schedule · outpatient	1	$162	$162	—	—	—	$162 – $162

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