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.
Generation details were not recorded for this description.
Original text from hospital filings
Fee Schedule
Low
$67
Average
$284
Median
$153
High
$1.5k
Each payer's average rate across its hospitals, under the methodology and billing class chosen below.
13 payers; the 90th percentile is 5.5× 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 | Anthem facility · fee schedule · outpatient · +1 other terms | 10 | $250 | $281 | $69 | 25% | — | $46 – $357 |
| 2 | Bcbs Mn fee schedule · outpatient · +1 other terms | 7 | $1.1k | $1.1k | $358 | 33% | — | $551 – $1.3k |
| 3 | Molina facility · case rate · outpatient · +1 other terms | 4 | $105 | $110 | $27 | 24% | — | $78 – $152 |
| 4 | Aetna fee schedule · outpatient · +3 other terms | 3 | $765 | $675 | $127 | 19% | — | $495 – $765 |
| 5 | Blue Cross Blue Shield facility · fee schedule · outpatient · +1 other terms | 3 | $188 | $188 | $27 | 14% | — | $148 – $231 |
| 6 | Humana facility · case rate · outpatient | 3 | $65 | $67 | $3 | 5% | — | $65 – $72 |
| 7 | Sanford Health Plan fee schedule · outpatient · +1 other terms | 3 | $153 | $153 | — | — | — | $153 – $153 |
| 8 | Wellmark facility · case rate · outpatient | 3 | $258 | $226 | $71 | 32% | — | $105 – $284 |
| 9 | UnitedHealthcare facility · fee schedule · outpatient · +1 other terms | 2 | $98 | $133 | $39 | 29% | — | $46 – $151 |
| 10 | Aetna Better Health facility · case rate · outpatient | 1 | $77 | $77 | $2 | 2% | — | $75 – $79 |
| 11 | Amerihealth Caritas facility · case rate · outpatient | 1 | $78 | $78 | — | — | — | $78 – $78 |
| 12 | Bcbs Id professional · fee schedule · outpatient | 1 | $153 | $153 | — | — | — | $153 – $153 |
| 13 | Kaiser facility · fee schedule · outpatient | 1 | $466 | $466 | — | — | — | $466 – $466 |
← Hospitals reporting HCPCS C9497 · Snapshot 20261112T181611Z-3fa9fb76