Dental bleaching home application kit

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

External bleaching home app

Payers reporting HCPCS D9975

Payer pricing summary

Low

Average

$163

Median

$127

High

$503

Payer rate distribution

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#
1	Molina facility · case rate · outpatient · +5 other terms	29	$89	$135	$81	60%	—	$37 – $338
2	Aetna fee schedule · outpatient · +6 other terms	22	$41	$133	$128	97%	—	$30 – $469
3	Blue Cross Blue Shield facility · fee schedule · outpatient · +4 other terms	20	$394	$302	$141	47%	—	$106 – $419
4	UnitedHealthcare professional · fee schedule · outpatient · +6 other terms	19	$94	$137	$59	43%	—	$77 – $233
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 · +1 other terms	13	$50	$71	$42	59%	—	$44 – $167
8	Highmark fee schedule · outpatient · +1 other terms	11	$130	$131	$11	8%	—	$107 – $242
9	Humana fee schedule · outpatient · +3 other terms	11	$303	$257	$98	38%	—	$70 – $339
10	Cigna professional · fee schedule · outpatient · +3 other terms	10	$74	$65	$13	19%	—	$47 – $74
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	$360	$360	—	—	—	$360 – $360
14	Oscar professional · percent of total billed charges · outpatientfrom % of charges	4	$102	$102	—	—	—	$102 – $102
15	Medica fee schedule · outpatient · +2 other terms	3	$134	$134	—	—	—	$134 – $134
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	$1	$1	—	—	—	$1 – $1
19	Bcbs Mn fee schedule · outpatient	1	$419	$419	—	—	—	$419 – $419
20	Bcbs Nv fee schedule · outpatient	1	$55	$55	—	—	—	$55 – $55
21	Bcbs Tx percent of total billed charges · outpatientfrom % of charges	1	$68	$68	$8	11%	—	$60 – $75
22	Bcbs Vt professional · fee schedule · outpatient	1	$30	$30	—	—	—	$30 – $30
23	Regence facility · fee schedule · outpatient	1	$97	$97	—	—	—	$97 – $97
24	WellCare facility · case rate · outpatient	1	$176	$176	—	—	—	$176 – $176