Diagnostic bilateral mammogram with computer-aided detection

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

HC DX MAMMO INCL CAD BI

Payers reporting HCPCS G0204

Payer pricing summary

Low

$33

Average

$369

Median

$355

High

$1.1k

Payer rate distribution

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#
1	Blue Cross Blue Shield fee schedule · outpatient · +10 other terms	35	$410	$433	$122	28%	—	$67 – $660
2	Cigna fee schedule · outpatient · +17 other terms	35	$283	$281	$101	36%	—	$148 – $597
3	Aetna fee schedule · outpatient · +14 other terms	33	$235	$381	$297	78%	—	$109 – $1.2k
4	Anthem facility · fee schedule · outpatient · +10 other terms	11	$129	$682	$2.0k	290%	—	$20 – $8.1k
5	UnitedHealthcare fee schedule · outpatient · +17 other terms	11	$150	$150	$82	55%	—	$46 – $252
6	MultiPlan per diem · outpatient · +9 other terms	7	$240	$239	$4	2%	—	$235 – $244
7	Phcs fee schedule · inpatient · +5 other terms	6	$234	$234	—	—	—	$234 – $234
8	Humana fee schedule · outpatient · +11 other terms	5	$109	$131	$30	23%	—	$109 – $188
9	Medica fee schedule · outpatient · +3 other terms	5	$171	$171	—	—	—	$171 – $171
10	Kaiser per diem · outpatient · +6 other terms	4	$174	$176	$17	9%	—	$155 – $198
11	WellCare fee schedule · outpatient · +4 other terms	4	$113	$113	—	—	—	$113 – $113
12	Medcost professional · percent of total billed charges · inpatientfrom % of charges · +1 other terms	3	$596	$596	—	—	—	$596 – $596
13	Molina facility · fee schedule · outpatient · +3 other terms	3	$20	$130	$117	90%	—	$20 – $299
14	Ambetter per diem · inpatient · +2 other terms	2	$793	$793	$324	41%	—	$469 – $1.1k
15	Bcbs Ks percent of total billed charges · outpatientfrom % of charges	2	$195	$195	$9	4%	—	$185 – $202
16	Bcbs Ok per diem · inpatient	2	$481	$481	—	—	—	$481 – $481
17	Devoted case rate · inpatient · +3 other terms	2	$793	$793	$324	41%	—	$469 – $1.1k
18	Healthcare Highways percent of total billed charges · inpatientfrom % of charges	2	$361	$361	—	—	—	$361 – $361
19	Magellan facility · percent of total billed charges · outpatientfrom % of charges · +1 other terms	2	$886	$930	$123	13%	—	$756 – $1.0k
20	Medicaid case rate · both · +3 other terms	2	$149	$149	—	—	—	$149 – $149
21	Tricare case rate · inpatient · +1 other terms	2	$793	$793	$324	41%	—	$469 – $1.1k
22	Aetna Better Health facility · case rate · outpatient · +1 other terms	1	$34	$34	$0	1%	—	$34 – $35
23	Amerihealth Caritas facility · case rate · outpatient	1	$35	$35	—	—	—	$35 – $35
24	Bcbs Ca facility · other · outpatient · +2 other terms	1	$1.1k	$1.1k	$157	14%	—	$897 – $1.4k
25	Bcbs Tx percent of total billed charges · outpatientfrom % of charges	1	$75	$75	$9	11%	—	$66 – $83

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