Athletic mouthguard fabrication

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

Fabrication athletic guard

Payers reporting HCPCS D9941

Payer pricing summary

Low

$35

Average

$219

Median

$158

High

$1.8k

Payer rate distribution

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#
1	Humana fee schedule · outpatient · +9 other terms	33	$359	$1.4k	$2.2k	161%	—	$55 – $8.3k
2	Molina facility · case rate · outpatient · +8 other terms	29	$89	$135	$81	60%	—	$37 – $338
3	Aetna fee schedule · outpatient · +10 other terms	27	$82	$162	$146	90%	—	$34 – $619
4	UnitedHealthcare professional · fee schedule · outpatient · +13 other terms	24	$88	$110	$37	34%	—	$49 – $206
5	Anthem professional · fee schedule · outpatient · +6 other terms	17	$89	$135	$72	53%	—	$61 – $294
6	Caresource facility · case rate · outpatient · +2 other terms	15	$53	$57	$13	23%	—	$36 – $90
7	Optum facility · case rate · outpatient · +1 other terms	13	$50	$71	$42	59%	—	$44 – $167
8	Blue Cross Blue Shield facility · fee schedule · outpatient · +9 other terms	11	$247	$262	$42	16%	—	$247 – $389
9	Cigna professional · fee schedule · outpatient · +6 other terms	10	$45	$45	$1	2%	—	$45 – $47
10	Highmark fee schedule · outpatient · +2 other terms	10	$121	$121	—	—	—	$121 – $121
11	Aetna Better Health facility · case rate · outpatient · +1 other terms	7	$211	$208	$9	4%	—	$175 – $211
12	Amerihealth Caritas facility · case rate · outpatient · +2 other terms	7	$193	$196	$6	3%	—	$193 – $211
13	Medicaid fee schedule · outpatient · +1 other terms	7	$343	$343	—	—	—	$343 – $343
14	Medica fee schedule · outpatient · +3 other terms	5	$81	$97	$62	63%	—	$53 – $210
15	MultiPlan professional · percent of total billed charges · outpatientfrom % of charges · +5 other terms	5	$315	$256	$88	34%	—	$90 – $315
16	Kaiser fee schedule · outpatient · +1 other terms	4	$344	$333	$97	29%	—	$152 – $523
17	Oscar professional · percent of total billed charges · outpatientfrom % of charges	4	$89	$76	$25	33%	—	$25 – $89
18	Wellmark facility · case rate · outpatient	3	$573	$503	$159	32%	—	$234 – $633
19	Excellus fee schedule · outpatient · +1 other terms	2	$324	$334	$285	85%	—	$85 – $711
20	Bcbs Id professional · fee schedule · outpatient	1	$112	$112	—	—	—	$112 – $112
21	Bcbs Mn fee schedule · outpatient	1	$247	$247	—	—	—	$247 – $247
22	Bcbs Nv fee schedule · outpatient	1	$55	$55	—	—	—	$55 – $55
23	Bcbs Ny percent of total billed charges · bothfrom % of charges	1	$110	$110	—	—	—	$110 – $110
24	Bcbs Tx percent of total billed charges · outpatientfrom % of charges	1	$135	$135	$15	11%	—	$120 – $150
25	Bcbs Vt professional · fee schedule · outpatient	1	$72	$72	—	—	—	$72 – $72

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