APC 904

Testosterone pellet implant, 75 mg

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

Testosterone pellet 75 mg

Payers reporting APC 904

Payer pricing summary

Low

$54

Average

$86

Median

$76

High

$151

Payer rate distribution

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Filter by billing class

#
1	UnitedHealthcare fee schedule · outpatient · +2 other terms	153	$75	$75	$1	1%	—	$73 – $78
2	Humana fee schedule · outpatient · +1 other terms	148	$74	$77	$22	28%	—	$70 – $298
3	Aetna fee schedule · outpatient · +1 other terms	135	$75	$75	$1	2%	—	$72 – $82
4	WellCare fee schedule · outpatient · +1 other terms	127	$77	$77	$3	3%	—	$74 – $98
5	Devoted fee schedule · outpatient	122	$74	$74	$1	1%	—	$73 – $78
6	Cigna Healthspring fee schedule · outpatient	110	$77	$75	$2	3%	—	$73 – $80
7	Blue Cross Blue Shield fee schedule · outpatient · +1 other terms	105	$76	$75	$1	1%	—	$73 – $77
8	Molina fee schedule · outpatient	55	$110	$109	$43	39%	—	$76 – $195
9	Superior Healthplan fee schedule · outpatient	40	$78	$78	$0	1%	—	$76 – $79
10	Anthem fee schedule · outpatient	24	$74	$75	$1	1%	—	$73 – $77
11	Oscar fee schedule · outpatient	24	$73	$75	$2	3%	—	$73 – $78
12	Amerihealth Caritas fee schedule · outpatient	17	$89	$88	$2	3%	—	$83 – $89
13	Clover fee schedule · outpatient	15	$79	$78	$1	1%	—	$76 – $79
14	Kaiser fee schedule · outpatient	13	$76	$76	$0	1%	—	$74 – $76
15	Cigna fee schedule · outpatient · +1 other terms	9	$76	$77	$2	3%	—	$76 – $80
16	Optum fee schedule · outpatient	8	$74	$116	$54	47%	—	$73 – $187
17	Highmark case rate · outpatient	3	$117	$112	$38	34%	—	$76 – $167
18	Excellus case rate · outpatient	2	$151	$151	$20	13%	—	$132 – $171
19	Ambetter fee schedule · outpatient	1	$54	$54	$6	10%	—	$48 – $60
20	Magellan fee schedule · outpatient	1	$74	$74	—	—	—	$74 – $74
21	Medicare facility · fee schedule · outpatient	1	$75	$75	—	—	—	$75 – $75