Replacement cushions for jaw rehabilitation device

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

Repl cushions for jaw motion

Payers reporting HCPCS E1701

Payer pricing summary

Low

Average

$19

Median

$15

High

$62

Payer rate distribution

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#
1	Humana fee schedule · outpatient · +10 other terms	299	$15	$22	$23	104%	—	$7 – $111
2	UnitedHealthcare fee schedule · outpatient · +10 other terms	287	$15	$14	$2	14%	—	$6 – $16
3	Aetna fee schedule · outpatient · +7 other terms	274	$15	$16	$9	53%	—	$1 – $101
4	WellCare fee schedule · outpatient · +4 other terms	184	$15	$16	$3	17%	—	$13 – $29
5	Blue Cross Blue Shield fee schedule · outpatient · +7 other terms	179	$15	$17	$8	46%	—	$0 – $52
6	Devoted fee schedule · outpatient · +2 other terms	163	$15	$15	$0	3%	—	$14 – $16
7	Cigna Healthspring fee schedule · outpatient · +1 other terms	116	$15	$15	$0	3%	—	$14 – $16
8	Molina fee schedule · outpatient · +4 other terms	95	$20	$20	$8	39%	—	$11 – $38
9	Cigna fee schedule · outpatient · +6 other terms	85	$16	$17	$5	29%	—	$14 – $44
10	Anthem fee schedule · outpatient · +6 other terms	73	$15	$15	$1	9%	—	$13 – $25
11	Superior Healthplan fee schedule · outpatient · +1 other terms	40	$15	$15	$0	0%	—	$14 – $15
12	Kaiser fee schedule · outpatient · +4 other terms	39	$15	$15	$0	2%	—	$15 – $15
13	Clover fee schedule · outpatient · +1 other terms	37	$15	$15	$1	3%	—	$14 – $16
14	Bcbs Tx fee schedule · outpatient	31	$13	$14	$4	29%	—	$10 – $49
15	Optum fee schedule · outpatient · +1 other terms	25	$15	$17	$7	40%	—	$14 – $36
16	Oscar fee schedule · outpatient · +2 other terms	24	$14	$15	$0	3%	—	$14 – $15
17	Caresource facility · case rate · outpatient · +4 other terms	20	$11	$15	$7	48%	—	$7 – $30
18	Medicare fee schedule · outpatient	18	$15	$14	$1	8%	—	$12 – $15
19	Amerihealth Caritas fee schedule · outpatient · +1 other terms	16	$17	$17	—	—	—	$17 – $17
20	Wellmark fee schedule · both · +1 other terms	13	$13	$13	$0	4%	—	$10 – $13
21	Aetna Better Health fee schedule · outpatient · +2 other terms	12	$7	$10	$4	36%	—	$7 – $15
22	Ambetter case rate · outpatient · +5 other terms	12	$20	$21	$1	6%	—	$20 – $24
23	Baylor Scott White Health Plan facility · percent of total billed charges · outpatientfrom % of charges	12	$43	$38	$10	26%	—	$13 – $46
24	Bcbs Mn fee schedule · outpatient · +4 other terms	12	$13	$13	$3	26%	—	$7 – $16
25	Bcbs Nj fee schedule · outpatient	12	$14	$31	$21	68%	—	$14 – $64

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