Internal 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

Intrnl bleaching per tooth

Payers reporting HCPCS D9974

Payer pricing summary

Low

$59

Average

$2.7k

Median

$201

High

$31.3k

Payer rate distribution

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#
1	Humana fee schedule · outpatient · +6 other terms	70	$337	$484	$290	60%	—	$95 – $858
2	Molina facility · case rate · outpatient · +6 other terms	29	$89	$135	$81	60%	—	$37 – $338
3	Aetna fee schedule · outpatient · +10 other terms	24	$90	$183	$162	89%	—	$54 – $691
4	UnitedHealthcare professional · fee schedule · outpatient · +11 other terms	20	$151	$180	$63	35%	—	$69 – $342
5	Anthem professional · fee schedule · outpatient · +6 other terms	17	$141	$164	$94	58%	—	$33 – $441
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 · +8 other terms	12	$380	$1.4k	$4.6k	326%	—	$380 – $22k
9	Highmark fee schedule · outpatient · +1 other terms	11	$186	$185	$12	6%	—	$107 – $242
10	Cigna professional · fee schedule · outpatient · +4 other terms	10	$63	$66	$4	6%	—	$63 – $72
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 · +3 other terms	5	$114	$134	$82	61%	—	$74 – $284
14	MultiPlan professional · percent of total billed charges · outpatientfrom % of charges · +3 other terms	5	$315	$299	$31	11%	—	$236 – $315
15	Tricare facility · fee schedule · outpatient · +1 other terms	5	$50k	$35.8k	$22.5k	63%	—	$197 – $50k
16	Oscar professional · percent of total billed charges · outpatientfrom % of charges	4	$89	$89	—	—	—	$89 – $89
17	Wellmark facility · case rate · outpatient	3	$573	$503	$159	32%	—	$234 – $633
18	Medicaid facility · case rate · outpatient	2	$176	$176	—	—	—	$176 – $176
19	Phcs facility · percent of total billed charges · inpatientfrom % of charges · +1 other terms	2	$167	$167	—	—	—	$167 – $167
20	Bcbs Id professional · fee schedule · outpatient	1	$186	$186	—	—	—	$186 – $186
21	Bcbs Mn fee schedule · outpatient	1	$380	$380	—	—	—	$380 – $380
22	Bcbs Nv fee schedule · outpatient	1	$82	$82	—	—	—	$82 – $82
23	Bcbs Ny percent of total billed charges · bothfrom % of charges	1	$217	$217	—	—	—	$217 – $217
24	Bcbs Tx percent of total billed charges · outpatientfrom % of charges	1	$116	$116	$13	11%	—	$103 – $129
25	Bcbs Vt professional · fee schedule · outpatient	1	$126	$126	—	—	—	$126 – $126

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