CPT 0104A
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
Fee Schedule
Low
$18
Average
$87
Median
$54
High
$517
Each payer's average rate across its hospitals, under the methodology and billing class chosen below.
27 payers; the 90th percentile is 4.6× the 10th. Each bar is a price range and its height is how many payers fall in it. Hover a bar, or a row in the ladder, for details.
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| # | ||||||||
|---|---|---|---|---|---|---|---|---|
| 1 | Molina facility · case rate · outpatient · +7 other terms | 27 | $25 | $25 | $10 | 41% | — | $11 – $57 |
| 2 | UnitedHealthcare fee schedule · outpatient · +12 other terms | 22 | $44 | $41 | $19 | 48% | — | $11 – $76 |
| 3 | Blue Cross Blue Shield fee schedule · outpatient · +9 other terms | 19 | $145 | $106 | $49 | 46% | — | $32 – $165 |
| 4 | MultiPlan fee schedule · inpatient · +7 other terms | 18 | $66 | $68 | $5 | 7% | — | $58 – $75 |
| 5 | Medica fee schedule · outpatient · +1 other terms | 17 | $58 | $60 | $13 | 21% | — | $26 – $76 |
| 6 | Anthem facility · case rate · outpatient · +3 other terms | 15 | $15 | $17 | $4 | 23% | — | $11 – $26 |
| 7 | Caresource facility · case rate · outpatient · +2 other terms | 15 | $16 | $17 | $4 | 23% | — | $11 – $27 |
| 8 | Optum facility · case rate · outpatient | 13 | $15 | $18 | $5 | 27% | — | $13 – $26 |
| 9 | Humana fee schedule · outpatient · +7 other terms | 11 | $45 | $44 | $11 | 26% | — | $26 – $57 |
| 10 | Highmark fee schedule · outpatient · +3 other terms | 10 | $44 | $44 | — | — | — | $44 – $44 |
← Hospitals reporting CPT 0104A · Snapshot 20261113T090226Z-3ce6c0b8