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
CLTX PALATAL/MAX FX WIRE FIX
Low
$718
Average
$3.6k
Median
$3.3k
High
$8.9k
Each payer's average rate across its hospitals, under the methodology and billing class chosen below.
63 payers; the 90th percentile is 4.5× 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 | UnitedHealthcare fee schedule · outpatient · +27 other terms | 504 | $3.2k | $3.6k | $4.2k | 116% | — | $1 – $95.3k |
| 2 | Aetna fee schedule · outpatient · +28 other terms | 443 | $3.6k | $4.6k | $4.3k | 93% | — | $1 – $48.0k |
| 3 | Blue Cross Blue Shield fee schedule · outpatient · +25 other terms | 350 | $4.5k | $5.8k | $4.0k | 69% | — | $1 – $41.4k |
| 4 | Humana fee schedule · outpatient · +24 other terms | 347 | $3.2k | $2.8k | $1.6k | 58% | — | $1 – $16.7k |
| 5 | Cigna case rate · outpatient · +23 other terms | 298 | $7.1k | $8.1k | $5.7k | 70% | — | $1 – $40.7k |
| 6 | Molina fee schedule · outpatient · +23 other terms | 216 | $2.4k | $1.9k | $1.7k | 89% | — | $1 – $7.7k |
| 7 | WellCare fee schedule · outpatient · +13 other terms | 154 | $3.4k | $3.5k | $1.3k | 36% | — | $390 – $7.6k |
| 8 | Oscar case rate · outpatient · +16 other terms | 137 | $5.6k | $5.3k | $1.5k | 28% | — | $2.4k – $10.1k |
| 9 | Anthem fee schedule · outpatient · +20 other terms | 130 | $3.1k | $3.1k | $4.0k | 131% | — | $339 – $24.3k |
| 10 | Kaiser fee schedule · outpatient · +17 other terms | 95 | $4.1k | $5.0k | $4.0k | 79% | — | $339 – $22.4k |
| 11 | Ambetter fee schedule · outpatient · +12 other terms | 76 | $5.7k | $4.4k | $2.4k | 54% | — | $804 – $8.0k |
| 12 | Aetna Better Health fee schedule · outpatient · +13 other terms | 70 | $1.1k | $1.1k | $366 | 32% | — | $507 – $3.0k |
| 13 | Healthcare Highways case rate · outpatient · +3 other terms | 69 | $3.8k | $4.2k | $963 | 23% | — | $2.7k – $5.5k |
| 14 | Devoted fee schedule · outpatient · +8 other terms | 62 | $3.3k | $3.0k | $930 | 31% | — | $540 – $3.7k |
| 15 | MultiPlan fee schedule · outpatient · +19 other terms | 59 | $5.2k | $5.8k | $2.7k | 46% | — | $1.7k – $13.7k |
| 16 | Caresource fee schedule · outpatient · +13 other terms | 52 | $2.1k | $2.1k | $1.5k | 74% | — | $1 – $5.7k |
| 17 | Tricare fee schedule · outpatient · +12 other terms | 40 | $3.8k | $3.7k | $712 | 19% | — | $3.0k – $5.4k |
| 18 | Superior Healthplan case rate · outpatient · +4 other terms | 38 | $948 | $1.0k | $549 | 54% | — | $929 – $4.9k |
| 19 | Optum fee schedule · outpatient · +17 other terms | 37 | $3.0k | $3.6k | $2.9k | 80% | — | $540 – $12.2k |
| 20 | Amerihealth Caritas case rate · outpatient · +7 other terms | 33 | $700 | $5.2k | $4.3k | 82% | — | $662 – $10.5k |
| 21 | Clover fee schedule · outpatient · +6 other terms | 32 | $3.5k | $3.5k | $218 | 6% | — | $3.0k – $4.0k |
| 22 | Phcs fee schedule · outpatient · +13 other terms | 30 | $2.6k | $4.1k | $2.5k | 61% | — | $1.6k – $7.8k |
| 23 | Cigna Healthspring fee schedule · outpatient · +4 other terms | 29 | $931 | $2.2k | $1.2k | 53% | — | $931 – $3.4k |
| 24 | First Health fee schedule · outpatient · +17 other terms | 28 | $3.5k | $4.4k | $5.1k | 115% | — | $619 – $16.3k |
| 25 | Medica case rate · outpatient · +14 other terms | 28 | $2.9k | $3.3k | $1.2k | 37% | — | $1.1k – $6.3k |
← Hospitals reporting CPT 21421 · Snapshot 20261113T090226Z-3ce6c0b8