Tricyclic antidepressant drug level test

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

"ANTIDEPRESSANTS, TRICYCLIC AND OTHER CYCLICALS, 3-5 , IMIPRAMINE"

Payers reporting CPT 80336

Payer pricing summary

Low

Average

$208

Median

$81

High

$3.2k

Payer rate distribution

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Filter by billing class

#
1	Aetna fee schedule · outpatient · +18 other terms	194	$0	$77	$650	848%	—	$0 – $8.4k
2	UnitedHealthcare fee schedule · outpatient · +18 other terms	182	$17	$20	$17	85%	—	$1 – $145
3	Humana fee schedule · outpatient · +14 other terms	114	$61	$77	$58	75%	—	$0 – $205
4	Blue Cross Blue Shield fee schedule · outpatient · +17 other terms	98	$20	$58	$82	142%	—	$1 – $424
5	Molina fee schedule · outpatient · +13 other terms	87	$19	$19	$10	51%	—	$1 – $135
6	Aetna Better Health fee schedule · outpatient · +8 other terms	69	$18	$18	$5	26%	—	$0 – $26
7	Anthem fee schedule · outpatient · +16 other terms	47	$28	$24	$38	157%	—	$0 – $379
8	Medica facility · percent of total billed charges · outpatientfrom % of charges · +1 other terms	25	$75	$67	$31	47%	—	$27 – $138
9	Highmark fee schedule · outpatient · +9 other terms	20	$15	$18	$12	70%	—	$5 – $68
10	Medicaid facility · fee schedule · outpatient · +6 other terms	18	$27	$28	$10	36%	—	$15 – $66
11	WellCare fee schedule · outpatient · +7 other terms	16	$66	$60	$27	45%	—	$5 – $118
12	Caresource facility · case rate · outpatient · +5 other terms	15	$28	$30	$7	23%	—	$19 – $47
13	Cigna Healthspring fee schedule · outpatient · +2 other terms	15	$18	$18	—	—	—	$18 – $18
14	Bcbs Tx fee schedule · outpatient	13	$20	$21	$0	1%	—	$20 – $21
15	First Health fee schedule · outpatient · +9 other terms	13	$17	$17	$2	14%	—	$0 – $17
16	Optum facility · case rate · outpatient · +6 other terms	13	$25	$25	$10	39%	—	$7 – $42
17	Wellmark fee schedule · both · +6 other terms	13	$25	$25	—	—	—	$25 – $25
18	Bcbs Mn fee schedule · outpatient · +3 other terms	12	$83	$64	$34	53%	—	$31 – $104
19	Ambetter fee schedule · outpatient · +7 other terms	11	$17	$17	$1	5%	—	$17 – $20
20	Cigna fee schedule · outpatient · +14 other terms	11	$43	$59	$69	116%	—	$5 – $379
21	Magellan percent of total billed charges · outpatientfrom % of charges · +4 other terms	10	$222	$280	$148	53%	—	$17 – $475
22	Healthcare Highways percent of total billed charges · outpatientfrom % of charges · +1 other terms	8	$313	$402	$299	74%	—	$193 – $1.3k
23	Amerihealth Caritas fee schedule · outpatient · +7 other terms	7	$63	$50	$23	47%	—	$4 – $63
24	Carefirst facility · fee schedule · both · +6 other terms	7	$140	$205	$142	69%	—	$106 – $525
25	Excellus facility · fee schedule · both · +3 other terms	7	$139	$139	$143	102%	—	$5 – $525

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