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
Tomo comp series images
Low
$24
Average
$158
Median
$107
High
$683
Each payer's average rate across its hospitals, under the methodology and billing class chosen below.
20 payers; the 90th percentile is 10.9× 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 | Molina facility · case rate · outpatient · +5 other terms | 29 | $423 | $335 | $333 | 99% | — | $21 – $1.0k |
| 2 | Aetna fee schedule · outpatient · +5 other terms | 25 | $60 | $122 | $89 | 73% | — | $39 – $509 |
| 3 | UnitedHealthcare facility · case rate · outpatient · +5 other terms | 18 | $593 | $534 | $295 | 55% | — | $24 – $1.0k |
| 4 | Anthem facility · case rate · outpatient · +5 other terms | 15 | $604 | $660 | $155 | 23% | — | $411 – $1.0k |
| 5 | Caresource facility · case rate · outpatient · +1 other terms | 15 | $615 | $661 | $151 | 23% | — | $411 – $1.0k |
| 6 | Optum facility · case rate · outpatient · +1 other terms | 13 | $546 | $533 | $253 | 47% | — | $23 – $927 |
| 7 | Blue Cross Blue Shield facility · fee schedule · outpatient · +3 other terms | 10 | $171 | $171 | — | — | — | $171 – $171 |
| 8 | Cigna professional · fee schedule · outpatient · +1 other terms | 8 | $50 | $50 | — | — | — | $50 – $50 |
| 9 | Humana facility · case rate · outpatient · +2 other terms | 8 | $24 | $25 | $1 | 5% | — | $24 – $26 |
| 10 | Aetna Better Health facility · case rate · outpatient | 7 | $29 | $29 | $0 | 1% | — | $28 – $29 |
| 11 | Amerihealth Caritas facility · case rate · outpatient · +1 other terms | 7 | $26 | $27 | $1 | 3% | — | $26 – $29 |
| 12 | Medica fee schedule · outpatient · +2 other terms | 3 | $90 | $90 | — | — | — | $90 – $90 |
| 13 | Wellmark facility · case rate · outpatient | 3 | $91 | $80 | $25 | 32% | — | $37 – $101 |
| 14 | Medicaid facility · case rate · outpatient | 2 | $24 | $24 | — | — | — | $24 – $24 |
| 15 | Bcbs Id professional · fee schedule · outpatient | 1 | $105 | $105 | — | — | — | $105 – $105 |
| 16 | Bcbs Mn fee schedule · outpatient | 1 | $171 | $171 | — | — | — | $171 – $171 |
| 17 | Highmark fee schedule · outpatient | 1 | $44 | $44 | $18 | 42% | — | $31 – $70 |
| 18 | MultiPlan professional · percent of total billed charges · outpatientfrom % of charges | 1 | $225 | $225 | — | — | — | $225 – $225 |
| 19 | Oscar professional · percent of total billed charges · outpatientfrom % of charges | 1 | $64 | $64 | — | — | — | $64 – $64 |
| 20 | WellCare facility · case rate · outpatient | 1 | $24 | $24 | — | — | — | $24 – $24 |
← Hospitals reporting HCPCS D0372 · Snapshot 20261112T181611Z-3fa9fb76