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.
Original text from hospital filings
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56 payers file a negotiated rate for this code. Each is shown once, under the terms the most hospitals file it under; rates under different terms (billing class, payment method, setting) are never blended, so open a payer to see them all. Figures are hospital-level averages; the median is across hospitals.
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Filter by billing class
| # | |||||
|---|---|---|---|---|---|
| 1 | UnitedHealthcare fee schedule · outpatient · +11 other terms | 602 | $762.17 | $824.33 | $145.00 – $6,840 |
| 2 | Aetna fee schedule · outpatient · +10 other terms | 552 | $782.80 | $1,633 | $414.96 – $16,345 |
| 3 | Humana fee schedule · outpatient · +14 other terms | 385 | $760.00 | $1,251 | $653.60 – $7,402 |
| 4 | Blue Cross Blue Shield fee schedule · outpatient · +10 other terms | 371 | $1,009 | $1,585 | $1.00 – $12,282 |
| 5 | Cigna fee schedule · outpatient · +8 other terms | 320 | $1,082 | $1,763 | $345.80 – $7,655 |
| 6 | WellCare fee schedule · outpatient · +7 other terms | 247 | $782.80 | $809.21 | $747.84 – $1,512 |
| 7 | Molina fee schedule · outpatient · +9 other terms | 201 | $1,119 | $1,082 | $274.06 – $2,280 |
| 8 | Devoted fee schedule · outpatient · +4 other terms | 193 | $760.00 | $768.88 | $744.80 – $879.08 |
| 9 | Oscar fee schedule · outpatient · +6 other terms | 160 | $1,471 | $1,638 | $744.80 – $2,326 |
| 10 | Anthem fee schedule · outpatient · +8 other terms | 141 | $836.00 | $1,566 | $304.00 – $5,700 |
| 11 | Cigna Healthspring fee schedule · outpatient · +3 other terms | 124 | $790.40 | $775.20 | $760.00 – $820.80 |
| 12 | Kaiser fee schedule · outpatient · +4 other terms | 76 | $775.20 | $1,048 | $608.00 – $2,842 |
| 13 | Ambetter facility · fee schedule · outpatient · +7 other terms | 65 | $1,342 | $1,431 | $760.00 – $1,938 |
| 14 | Superior Healthplan fee schedule · outpatient | 42 | $798.00 | $799.93 | $760.00 – $1,216 |
| 15 | Clover fee schedule · outpatient · +5 other terms | 41 | $775.20 | $779.17 | $760.00 – $798.00 |
| 16 | Optum fee schedule · outpatient · +6 other terms | 41 | $760.00 | $1,041 | $744.80 – $2,181 |
| 17 | Bcbs Tx fee schedule · outpatient · +1 other terms | 32 | $2,959 | $3,106 | $760.00 – $6,544 |
| 18 | Caresource fee schedule · outpatient · +5 other terms | 32 | $877.80 | $918.02 | $760.00 – $1,482 |
| 19 | Regence facility · fee schedule · outpatient · +3 other terms | 24 | $805.60 | $911.15 | $646.00 – $2,280 |
| 20 | First Health fee schedule · outpatient · +4 other terms | 21 | $760.00 | $1,036 | $760.00 – $1,520 |
| 21 | Medica facility · fee schedule · outpatient · +5 other terms | 20 | $760.00 | $757.54 | $258.45 – $1,967 |
| 22 | Amerihealth Caritas fee schedule · outpatient · +2 other terms | 19 | $1,026 | $968.65 | $760.00 – $1,140 |
| 23 | Healthpartners fee schedule · outpatient · +1 other terms | 19 | $2,298 | $2,257 | $775.20 – $2,580 |
| 24 | Medicare fee schedule · outpatient · +2 other terms | 18 | $744.80 | $746.18 | $744.80 – $760.00 |
| 25 | Medical Mutual fee schedule · outpatient · +1 other terms | 17 | $820.80 | $1,324 | $697.36 – $2,303 |
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