7 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 | Aetna percent of total billed charges · outpatientfrom % of charges | 2 | $12 | $17 | $16 | 96% | — | $3 – $37 |
| 2 | Cigna percent of total billed charges · outpatientfrom % of charges | 2 | $11 | $13 | $15 | 110% | — | $2 – $34 |
| 3 | Blue Cross Blue Shield percent of total billed charges · outpatientfrom % of charges | 1 | $19 | $19 | $16 | 82% | — | $3 – $39 |
| 4 | MultiPlan percent of total billed charges · outpatientfrom % of charges | 1 | $24 | $24 | $19 | 79% | — | $5 – $43 |
| 5 | Phcs percent of total billed charges · outpatientfrom % of charges | 1 | $22 | $22 | $17 | 77% | — | $5 – $39 |
| 6 | Superior Healthplan fee schedule · outpatient | 1 | $21 | $21 | $17 | 81% | — | $4 – $43 |
| 7 | UnitedHealthcare facility · case rate · outpatient · +1 other terms | 1 | $4.3k | $4.3k | — | — | — | $4.3k – $4.3k |
← Hospitals reporting CPT 12104 · Snapshot 20261110T010908Z-f52d80a4