External tooth bleaching per arch

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

Extrnl bleaching per arch

Payers reporting HCPCS D9972

Payer pricing summary

Low

$14

Average

$242

Median

$176

High

$1.9k

Payer rate distribution

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#
1	Humana fee schedule · outpatient · +6 other terms	70	$353	$558	$328	59%	—	$109 – $981
2	Molina facility · case rate · outpatient · +6 other terms	29	$89	$135	$81	60%	—	$37 – $338
3	Aetna fee schedule · outpatient · +9 other terms	24	$103	$215	$196	91%	—	$66 – $900
4	UnitedHealthcare fee schedule · outpatient · +11 other terms	20	$195	$209	$67	32%	—	$105 – $335
5	Anthem facility · case rate · outpatient · +6 other terms	15	$52	$57	$13	23%	—	$36 – $89
6	Caresource facility · case rate · outpatient · +1 other terms	15	$53	$57	$13	23%	—	$36 – $90
7	MultiPlan facility · percent of total billed charges · outpatientfrom % of charges · +3 other terms	13	$65	$87	$76	87%	—	$65 – $350
8	Optum facility · case rate · outpatient · +1 other terms	13	$50	$71	$42	59%	—	$44 – $167
9	Blue Cross Blue Shield facility · fee schedule · outpatient · +9 other terms	11	$502	$491	$34	7%	—	$389 – $502
10	Highmark fee schedule · outpatient · +1 other terms	11	$245	$243	$18	7%	—	$107 – $245
11	Cigna professional · fee schedule · outpatient · +5 other terms	10	$86	$88	$2	2%	—	$86 – $91
12	Clover facility · percent of total billed charges · outpatientfrom % of charges	10	$14	$14	—	—	—	$14 – $14
13	Aetna Better Health facility · case rate · outpatient	7	$211	$208	$9	4%	—	$175 – $211
14	Amerihealth Caritas facility · case rate · outpatient · +1 other terms	7	$193	$196	$6	3%	—	$193 – $211
15	Medica fee schedule · outpatient · +3 other terms	5	$156	$171	$90	52%	—	$102 – $333
16	Wellmark facility · case rate · outpatient	3	$573	$503	$159	32%	—	$234 – $633
17	Excellus fee schedule · outpatient · +1 other terms	2	$335	$335	—	—	—	$335 – $335
18	Medicaid facility · case rate · outpatient	2	$176	$176	—	—	—	$176 – $176
19	Bcbs Id professional · fee schedule · outpatient	1	$223	$223	—	—	—	$223 – $223
20	Bcbs Mn fee schedule · outpatient	1	$502	$502	—	—	—	$502 – $502
21	Bcbs Nv fee schedule · outpatient	1	$107	$107	—	—	—	$107 – $107
22	Bcbs Ny percent of total billed charges · bothfrom % of charges	1	$62	$62	—	—	—	$62 – $62
23	Bcbs Tx percent of total billed charges · outpatientfrom % of charges	1	$180	$180	$20	11%	—	$160 – $200
24	Bcbs Vt professional · fee schedule · outpatient	1	$144	$144	—	—	—	$144 – $144
25	Devoted professional · percent of total billed charges · inpatientfrom % of charges · +1 other terms	1	$81	$81	—	—	—	$81 – $81

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