External tooth bleaching per tooth

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 tooth

Payers reporting HCPCS D9973

Payer pricing summary

Low

Average

$120

Median

$92

High

$503

Payer rate distribution

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#
1	Humana fee schedule · outpatient · +6 other terms	70	$120	$123	$80	65%	—	$17 – $339
2	Molina facility · case rate · outpatient · +6 other terms	29	$89	$135	$81	60%	—	$37 – $338
3	Aetna fee schedule · outpatient · +8 other terms	24	$60	$116	$126	108%	—	$16 – $478
4	UnitedHealthcare fee schedule · outpatient · +10 other terms	18	$56	$89	$85	95%	—	$18 – $323
5	Anthem facility · case rate · outpatient · +5 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	Optum facility · case rate · outpatient	13	$50	$71	$42	59%	—	$44 – $167
8	Blue Cross Blue Shield facility · fee schedule · outpatient · +5 other terms	11	$119	$141	$83	59%	—	$107 – $389
9	Highmark fee schedule · outpatient · +1 other terms	11	$52	$55	$19	35%	—	$52 – $242
10	Cigna professional · fee schedule · outpatient · +4 other terms	10	$56	$51	$7	13%	—	$37 – $56
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	Medica fee schedule · outpatient · +2 other terms	5	$100	$115	$67	58%	—	$65 – $236
14	Wellmark facility · case rate · outpatient	3	$573	$503	$159	32%	—	$234 – $633
15	Medicaid facility · case rate · outpatient	2	$176	$176	—	—	—	$176 – $176
16	Bcbs Id professional · fee schedule · outpatient	1	$64	$64	—	—	—	$64 – $64
17	Bcbs Mn fee schedule · outpatient	1	$107	$107	—	—	—	$107 – $107
18	Bcbs Nv fee schedule · outpatient	1	$57	$57	—	—	—	$57 – $57
19	Bcbs Ny percent of total billed charges · bothfrom % of charges	1	$217	$217	—	—	—	$217 – $217
20	Bcbs Tx percent of total billed charges · outpatientfrom % of charges	1	$92	$92	$10	11%	—	$82 – $102
21	Bcbs Vt professional · fee schedule · outpatient	1	$24	$24	—	—	—	$24 – $24
22	Excellus percent of total billed charges · bothfrom % of charges	1	$217	$217	—	—	—	$217 – $217
23	First Health facility · percent of total billed charges · inpatientfrom % of charges · +1 other terms	1	$68	$68	—	—	—	$68 – $68
24	Healthpartners facility · fee schedule · outpatient	1	$56	$56	—	—	—	$56 – $56
25	MultiPlan facility · percent of total billed charges · inpatientfrom % of charges · +1 other terms	1	$58	$58	—	—	—	$58 – $58

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