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
Peri medicament w/seal, mand
Low
$1
Average
$5.4k
Median
$1.2k
High
$50k
Each payer's average rate across its hospitals, under the methodology and billing class chosen below.
27 payers; the 90th percentile is 107.9× 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.
Filter by billing methodology
Filter by billing class
| # | ||||||||
|---|---|---|---|---|---|---|---|---|
| 1 | UnitedHealthcare case rate · outpatient · +6 other terms | 270 | $6.3k | $5.2k | $4.0k | 76% | — | $1 – $30k |
| 2 | Molina facility · case rate · outpatient · +5 other terms | 29 | $1.5k | $4.9k | $19.5k | 395% | — | $139 – $111.7k |
| 3 | Aetna fee schedule · outpatient · +4 other terms | 20 | $70 | $441 | $740 | 168% | — | $45 – $2.1k |
| 4 | Anthem facility · case rate · outpatient · +5 other terms | 16 | $1.5k | $8.2k | $25.9k | 317% | — | $1.3k – $108.4k |
| 5 | Caresource facility · case rate · outpatient · +3 other terms | 15 | $1.5k | $8.6k | $26.7k | 309% | — | $1.4k – $108.4k |
| 6 | Cigna case rate · outpatient · +2 other terms | 13 | $2.4k | $2.7k | $1.1k | 41% | — | $1.2k – $5.1k |
| 7 | Optum facility · case rate · outpatient | 13 | $1.4k | $1.3k | $91 | 7% | — | $1.1k – $1.4k |
| 8 | Blue Cross Blue Shield facility · fee schedule · outpatient · +7 other terms | 11 | $164 | $179 | $45 | 25% | — | $164 – $314 |
| 9 | Ambetter case rate · outpatient | 10 | $2.0k | $2.0k | — | — | — | $2.0k – $2.0k |
| 10 | Humana facility · case rate · outpatient · +4 other terms | 8 | $1.2k | $1.2k | $56 | 5% | — | $1.2k – $1.3k |
| 11 | Aetna Better Health facility · case rate · outpatient | 7 | $1.4k | $1.4k | $63 | 5% | — | $1.2k – $1.4k |
| 12 | Amerihealth Caritas facility · case rate · outpatient · +2 other terms | 7 | $1.3k | $1.3k | $41 | 3% | — | $1.3k – $1.4k |
| 13 | Phcs percent of total billed charges · outpatientfrom % of charges | 5 | $37.5k | $37.5k | — | — | — | $37.5k – $37.5k |
| 14 | Tricare fee schedule · outpatient | 5 | $50k | $50k | — | — | — | $50k – $50k |
| 15 | First Health other · outpatient | 3 | $2.7k | $2.6k | $130 | 5% | — | $2.4k – $2.7k |
| 16 | Medica fee schedule · outpatient · +3 other terms | 3 | $646 | $646 | $543 | 84% | — | $104 – $1.2k |
| 17 | Wellmark facility · case rate · outpatient | 3 | $3.8k | $3.3k | $1.0k | 32% | — | $1.5k – $4.2k |
| 18 | Medicaid facility · case rate · outpatient | 2 | $1.2k | $1.2k | — | — | — | $1.2k – $1.2k |
| 19 | Bcbs Al other · outpatient | 1 | $179 | $179 | — | — | — | $179 – $179 |
| 20 | Bcbs Id professional · fee schedule · outpatient | 1 | $1 | $1 | — | — | — | $1 – $1 |
| 21 | Bcbs Mn fee schedule · outpatient | 1 | $164 | $164 | — | — | — | $164 – $164 |
| 22 | Bcbs Nv fee schedule · outpatient | 1 | $72 | $72 | — | — | — | $72 – $72 |
| 23 | Bcbs Vt professional · fee schedule · outpatient | 1 | $106 | $106 | — | — | — | $106 – $106 |
| 24 | Highmark fee schedule · outpatient | 1 | $84 | $84 | $35 | 42% | — | $59 – $133 |
| 25 | Medical Mutual fee schedule · outpatient | 1 | $1.1k | $1.1k | $80 | 7% | — | $966 – $1.1k |
← Hospitals reporting HCPCS D5996 · Snapshot 20261112T124536Z-e251e855