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 ANRCT MANO RCT SNSATN & BALO
Low
$95
Average
$683
Median
$604
High
$1.9k
Each payer's average rate across its hospitals, under the methodology and billing class chosen below.
53 payers; the 90th percentile is 4.3× 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 | Aetna fee schedule · outpatient · +24 other terms | 177 | $405 | $448 | $336 | 75% | — | $1 – $4.8k |
| 2 | UnitedHealthcare case rate · outpatient · +26 other terms | 169 | $2.1k | $2.1k | $1.5k | 73% | — | $400 – $22.4k |
| 3 | Blue Cross Blue Shield fee schedule · outpatient · +20 other terms | 143 | $531 | $913 | $602 | 66% | — | $78 – $2.6k |
| 4 | Humana facility · fee schedule · outpatient · +23 other terms | 89 | $375 | $367 | $58 | 16% | — | $149 – $478 |
| 5 | Cigna fee schedule · outpatient · +23 other terms | 63 | $417 | $641 | $426 | 66% | — | $364 – $1.9k |
| 6 | Molina facility · fee schedule · outpatient · +21 other terms | 63 | $381 | $382 | $119 | 31% | — | $194 – $957 |
| 7 | Anthem fee schedule · outpatient · +18 other terms | 58 | $920 | $937 | $498 | 53% | — | $8 – $2.7k |
| 8 | Ambetter facility · fee schedule · outpatient · +12 other terms | 55 | $646 | $652 | $145 | 22% | — | $170 – $807 |
| 9 | Kaiser fee schedule · outpatient · +13 other terms | 43 | $622 | $781 | $510 | 65% | — | $374 – $3.0k |
| 10 | Devoted facility · fee schedule · outpatient · +8 other terms | 36 | $353 | $376 | $29 | 8% | — | $343 – $429 |
| 11 | WellCare fee schedule · outpatient · +14 other terms | 36 | $445 | $438 | $33 | 7% | — | $343 – $499 |
| 12 | Oscar fee schedule · outpatient · +10 other terms | 30 | $782 | $719 | $171 | 24% | — | $440 – $1.1k |
| 13 | Baylor Scott White Health Plan facility · fee schedule · outpatient · +1 other terms | 25 | $474 | $473 | $94 | 20% | — | $356 – $620 |
| 14 | Caresource facility · fee schedule · outpatient · +14 other terms | 25 | $635 | $567 | $137 | 24% | — | $363 – $743 |
| 15 | Optum fee schedule · outpatient · +15 other terms | 22 | $382 | $595 | $298 | 50% | — | $359 – $1.4k |
| 16 | Superior Healthplan facility · fee schedule · outpatient · +2 other terms | 22 | $394 | $384 | $14 | 4% | — | $334 – $394 |
| 17 | Clover facility · fee schedule · outpatient · +3 other terms | 19 | $393 | $383 | $20 | 5% | — | $345 – $402 |
| 18 | Medicare fee schedule · outpatient · +10 other terms | 19 | $374 | $375 | $9 | 2% | — | $368 – $416 |
| 19 | Tricare facility · fee schedule · outpatient · +6 other terms | 17 | $398 | $712 | $1.3k | 177% | — | $175 – $5.7k |
| 20 | Medcost percent of total billed charges · bothfrom % of charges · +4 other terms | 15 | $748 | $1.5k | $752 | 51% | — | $705 – $2.3k |
| 21 | Regence facility · fee schedule · outpatient · +8 other terms | 15 | $393 | $395 | $11 | 3% | — | $378 – $429 |
| 22 | Medical Mutual facility · fee schedule · outpatient · +9 other terms | 14 | $353 | $446 | $296 | 66% | — | $192 – $1.4k |
| 23 | First Health fee schedule · outpatient · +9 other terms | 8 | $390 | $436 | $122 | 28% | — | $390 – $760 |
| 24 | MultiPlan other · both · +12 other terms | 8 | $401 | $401 | $0 | 0% | — | $401 – $402 |
| 25 | Medica professional · fee schedule · outpatient · +11 other terms | 7 | $373 | $295 | $113 | 38% | — | $133 – $403 |
← Hospitals reporting CPT 91125 · Snapshot 20261112T181611Z-3fa9fb76