Replacement of broken dental retainer

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

Replace broken retainer man

Payers reporting HCPCS D8704

Payer pricing summary

Low

$51

Average

$236

Median

$208

High

$697

Payer rate distribution

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#
1	Molina facility · case rate · outpatient · +5 other terms	29	$89	$230	$380	165%	—	$37 – $1.7k
2	Aetna fee schedule · outpatient · +7 other terms	22	$124	$237	$212	89%	—	$75 – $996
3	Blue Cross Blue Shield facility · fee schedule · outpatient · +6 other terms	20	$697	$808	$257	32%	—	$505 – $1.9k
4	UnitedHealthcare professional · fee schedule · outpatient · +9 other terms	19	$200	$264	$92	35%	—	$127 – $466
5	Anthem facility · case rate · outpatient · +5 other terms	16	$53	$135	$302	224%	—	$36 – $1.3k
6	Caresource facility · case rate · outpatient · +1 other terms	15	$53	$57	$13	23%	—	$36 – $90
7	Optum facility · case rate · outpatient · +2 other terms	13	$50	$71	$42	59%	—	$44 – $167
8	Cigna professional · fee schedule · outpatient · +3 other terms	10	$117	$111	$7	7%	—	$101 – $117
9	Humana facility · case rate · outpatient · +3 other terms	8	$176	$182	$9	5%	—	$176 – $193
10	Aetna Better Health facility · case rate · outpatient	7	$211	$208	$9	4%	—	$175 – $211
11	Amerihealth Caritas facility · case rate · outpatient · +2 other terms	7	$193	$196	$6	3%	—	$193 – $211
12	Medicaid fee schedule · outpatient · +1 other terms	7	$327	$327	—	—	—	$327 – $327
13	Kaiser fee schedule · outpatient · +1 other terms	4	$340	$327	$96	29%	—	$152 – $523
14	MultiPlan percent of total billed charges · outpatientfrom % of charges · +3 other terms	4	$262	$262	$23	9%	—	$229 – $294
15	Oscar professional · percent of total billed charges · outpatientfrom % of charges	4	$51	$51	—	—	—	$51 – $51
16	Medica fee schedule · outpatient · +2 other terms	3	$210	$210	—	—	—	$210 – $210
17	Wellmark facility · case rate · outpatient	3	$573	$503	$159	32%	—	$234 – $633
18	First Health percent of total billed charges · outpatientfrom % of charges · +2 other terms	2	$265	$265	$3	1%	—	$262 – $268
19	Bcbs Id professional · fee schedule · outpatient	1	$222	$222	—	—	—	$222 – $222
20	Bcbs Mn fee schedule · outpatient	1	$697	$697	—	—	—	$697 – $697
21	Bcbs Nv fee schedule · outpatient	1	$118	$118	—	—	—	$118 – $118
22	Bcbs Vt professional · fee schedule · outpatient	1	$185	$185	—	—	—	$185 – $185
23	Highmark fee schedule · outpatient	1	$152	$152	$63	42%	—	$107 – $242
24	Phcs percent of total billed charges · outpatientfrom % of charges	1	$294	$294	—	—	—	$294 – $294
25	Regence facility · fee schedule · outpatient	1	$207	$207	—	—	—	$207 – $207

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