Occlusal guard repair or relining

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

Repair/reline occlusal guard

Payers reporting HCPCS D9942

Payer pricing summary

Low

$53

Average

$164

Median

$158

High

$503

Payer rate distribution

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#
1	Humana fee schedule · outpatient · +6 other terms	70	$337	$340	$196	58%	—	$65 – $589
2	Molina facility · case rate · outpatient · +5 other terms	29	$89	$135	$81	60%	—	$37 – $338
3	Aetna fee schedule · outpatient · +7 other terms	22	$62	$155	$137	88%	—	$40 – $544
4	UnitedHealthcare professional · fee schedule · outpatient · +9 other terms	19	$103	$132	$46	35%	—	$57 – $245
5	Anthem professional · fee schedule · outpatient · +5 other terms	16	$74	$263	$360	137%	—	$73 – $1.4k
6	Caresource facility · case rate · outpatient · +1 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 · +4 other terms	11	$284	$300	$30	10%	—	$284 – $389
9	Highmark fee schedule · outpatient · +1 other terms	11	$78	$80	$16	20%	—	$78 – $242
10	Cigna professional · fee schedule · outpatient · +4 other terms	10	$53	$53	$1	2%	—	$53 – $55
11	Aetna Better Health facility · case rate · outpatient	7	$211	$208	$9	4%	—	$175 – $211
12	Amerihealth Caritas facility · case rate · outpatient · +1 other terms	7	$193	$196	$6	3%	—	$193 – $211
13	MultiPlan professional · percent of total billed charges · outpatientfrom % of charges	4	$270	$270	—	—	—	$270 – $270
14	Oscar professional · percent of total billed charges · outpatientfrom % of charges	4	$76	$76	—	—	—	$76 – $76
15	Medica fee schedule · outpatient · +2 other terms	3	$95	$95	—	—	—	$95 – $95
16	Wellmark facility · case rate · outpatient	3	$573	$503	$159	32%	—	$234 – $633
17	Medicaid facility · case rate · outpatient	2	$176	$176	—	—	—	$176 – $176
18	Bcbs Id professional · fee schedule · outpatient	1	$133	$133	—	—	—	$133 – $133
19	Bcbs Mn fee schedule · outpatient	1	$298	$298	—	—	—	$298 – $298
20	Bcbs Nv fee schedule · outpatient	1	$65	$65	—	—	—	$65 – $65
21	Bcbs Ny percent of total billed charges · bothfrom % of charges	1	$185	$185	—	—	—	$185 – $185
22	Bcbs Tx percent of total billed charges · outpatientfrom % of charges	1	$100	$100	$12	12%	—	$88 – $111
23	Bcbs Vt professional · fee schedule · outpatient	1	$86	$86	—	—	—	$86 – $86
24	Excellus percent of total billed charges · bothfrom % of charges	1	$185	$185	—	—	—	$185 – $185
25	Healthpartners facility · fee schedule · outpatient	1	$201	$201	—	—	—	$201 – $201

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