Unlisted pathology 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

PR PENTOXIFLLINE STIM SPERM

Payers reporting CPT 89240

Payer pricing summary

Low

$17

Average

$133

Median

$87

High

$1.2k

Payer rate distribution

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#
1	Medicare other · both · +8 other terms	22	$52	$52	$2	4%	1–10	$49 – $54
2	UnitedHealthcare fee schedule · outpatient · +24 other terms	596	$50	$74	$151	204%	—	$1 – $2.1k
3	Aetna fee schedule · outpatient · +17 other terms	381	$56	$133	$596	448%	—	$0 – $8.4k
4	Cigna fee schedule · outpatient · +16 other terms	379	$98	$96	$56	59%	—	$5 – $318
5	Blue Cross Blue Shield fee schedule · outpatient · +21 other terms	282	$89	$111	$63	57%	—	$1 – $446
6	Humana fee schedule · outpatient · +16 other terms	228	$54	$56	$29	52%	—	$1 – $384
7	WellCare fee schedule · outpatient · +10 other terms	128	$54	$59	$21	36%	—	$21 – $125
8	Anthem fee schedule · outpatient · +16 other terms	122	$54	$99	$109	110%	—	$0 – $381
9	Molina fee schedule · outpatient · +17 other terms	109	$63	$72	$30	42%	—	$1 – $225
10	Ambetter facility · fee schedule · outpatient · +9 other terms	68	$93	$195	$831	426%	—	$24 – $7.0k
11	Devoted fee schedule · outpatient · +6 other terms	65	$54	$54	$3	6%	—	$48 – $59
12	Kaiser fee schedule · outpatient · +12 other terms	65	$75	$98	$67	68%	—	$5 – $394
13	Caresource fee schedule · outpatient · +11 other terms	48	$66	$111	$68	62%	—	$1 – $206
14	Optum fee schedule · outpatient · +9 other terms	38	$52	$69	$35	51%	—	$47 – $192
15	MultiPlan fee schedule · outpatient · +12 other terms	36	$90	$97	$29	30%	—	$8 – $148
16	Oscar fee schedule · outpatient · +11 other terms	35	$109	$101	$22	21%	—	$61 – $149
17	Clover fee schedule · outpatient · +6 other terms	26	$58	$56	$4	8%	—	$47 – $63
18	Baylor Scott White Health Plan facility · fee schedule · outpatient · +1 other terms	25	$66	$66	$13	20%	—	$50 – $87
19	Bcbs Tx fee schedule · outpatient · +2 other terms	25	$193	$202	$86	43%	—	$50 – $426
20	Tricare fee schedule · outpatient · +9 other terms	23	$47	$49	$3	7%	—	$46 – $62
21	Superior Healthplan facility · fee schedule · outpatient · +2 other terms	21	$55	$54	$1	2%	—	$52 – $55
22	First Health fee schedule · outpatient · +10 other terms	16	$54	$55	$25	45%	—	$7 – $106
23	Highmark fee schedule · outpatient · +4 other terms	16	$71	$71	$27	38%	—	$4 – $225
24	Regence facility · case rate · outpatient · +5 other terms	16	$55	$66	$32	48%	—	$49 – $169
25	Medical Mutual facility · fee schedule · outpatient · +8 other terms	15	$49	$356	$1.3k	361%	—	$27 – $6.0k

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