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
HC PHENYLKETONES QUAL 4901UA
Low
$2
Average
$19
Median
$7
High
$498
Each payer's average rate across its hospitals, under the methodology and billing class chosen below.
59 payers; the 90th percentile is 5.3× 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 · +19 other terms | 645 | $4 | $4 | $4 | 83% | — | $1 – $145 |
| 2 | Aetna fee schedule · outpatient · +16 other terms | 611 | $4 | $36 | $405 | 1127% | — | $0 – $8.4k |
| 3 | Humana fee schedule · outpatient · +17 other terms | 435 | $4 | $8 | $10 | 120% | — | $3 – $49 |
| 4 | Cigna fee schedule · outpatient · +15 other terms | 426 | $7 | $9 | $7 | 78% | — | $2 – $88 |
| 5 | Blue Cross Blue Shield fee schedule · outpatient · +16 other terms | 399 | $6 | $9 | $9 | 100% | — | $1 – $86 |
| 6 | WellCare fee schedule · outpatient · +8 other terms | 269 | $4 | $4 | $1 | 16% | — | $2 – $8 |
| 7 | Molina fee schedule · outpatient · +14 other terms | 227 | $4 | $5 | $2 | 44% | — | $1 – $22 |
| 8 | Devoted fee schedule · outpatient · +4 other terms | 196 | $4 | $4 | $0 | 3% | — | $4 – $5 |
| 9 | Oscar fee schedule · outpatient · +10 other terms | 160 | $8 | $9 | $3 | 33% | — | $4 – $12 |
| 10 | Anthem fee schedule · outpatient · +13 other terms | 156 | $6 | $8 | $7 | 92% | — | $2 – $43 |
| 11 | Cigna Healthspring fee schedule · outpatient · +3 other terms | 125 | $4 | $4 | $0 | 6% | — | $4 – $6 |
| 12 | Ambetter fee schedule · outpatient · +8 other terms | 103 | $7 | $6 | $2 | 31% | — | $3 – $12 |
| 13 | Aetna Better Health fee schedule · outpatient · +9 other terms | 85 | $4 | $4 | $0 | 5% | — | $4 – $4 |
| 14 | Kaiser fee schedule · outpatient · +7 other terms | 77 | $4 | $5 | $3 | 49% | — | $2 – $15 |
| 15 | Caresource fee schedule · outpatient · +6 other terms | 63 | $4 | $4 | $1 | 22% | — | $4 – $9 |
| 16 | Optum fee schedule · outpatient · +10 other terms | 45 | $4 | $5 | $2 | 43% | — | $4 – $11 |
| 17 | Superior Healthplan fee schedule · outpatient · +3 other terms | 45 | $4 | $4 | $0 | 8% | — | $3 – $7 |
| 18 | Clover fee schedule · outpatient · +5 other terms | 41 | $4 | $4 | $0 | 2% | — | $4 – $4 |
| 19 | Amerihealth Caritas fee schedule · outpatient · +5 other terms | 39 | $4 | $4 | $1 | 27% | — | $1 – $9 |
| 20 | First Health fee schedule · outpatient · +10 other terms | 34 | $4 | $5 | $11 | 197% | — | $3 – $96 |
| 21 | Bcbs Tx fee schedule · outpatient · +1 other terms | 32 | $15 | $15 | $7 | 48% | — | $4 – $34 |
| 22 | Healthcare Highways fee schedule · outpatient | 29 | $9 | $10 | $2 | 18% | — | $5 – $11 |
| 23 | Regence facility · fee schedule · outpatient · +3 other terms | 26 | $4 | $5 | $2 | 44% | — | $3 – $12 |
| 24 | Highmark fee schedule · outpatient · +6 other terms | 23 | $4 | $4 | $2 | 49% | — | $2 – $22 |
| 25 | Tricare fee schedule · outpatient · +7 other terms | 22 | $4 | $4 | $0 | 5% | — | $4 – $5 |
← Hospitals reporting CPT 84035 · Snapshot 20261112T181611Z-3fa9fb76