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
Current percep threshold tst
Low
$24
Average
$188
Median
$166
High
$405
Each payer's average rate across its hospitals, under the methodology and billing class chosen below.
23 payers; the 90th percentile is 6.2× 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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Filter by billing class
| # | ||||||||
|---|---|---|---|---|---|---|---|---|
| 1 | Humana fee schedule · outpatient · +3 other terms | 67 | $295 | $442 | $236 | 53% | — | $142 – $719 |
| 2 | UnitedHealthcare fee schedule · outpatient · +5 other terms | 42 | $256 | $250 | $86 | 34% | — | $128 – $595 |
| 3 | Molina facility · case rate · outpatient · +5 other terms | 29 | $249 | $244 | $155 | 63% | — | $87 – $602 |
| 4 | Blue Cross Blue Shield facility · fee schedule · outpatient · +6 other terms | 23 | $106 | $157 | $112 | 71% | — | $102 – $565 |
| 5 | Anthem facility · case rate · outpatient · +6 other terms | 15 | $355 | $388 | $91 | 23% | — | $241 – $602 |
| 6 | Caresource facility · case rate · outpatient · +1 other terms | 15 | $362 | $388 | $89 | 23% | — | $241 – $613 |
| 7 | Aetna fee schedule · both · +7 other terms | 13 | $536 | $537 | $2 | 0% | — | $536 – $547 |
| 8 | Optum facility · case rate · outpatient | 13 | $321 | $324 | $128 | 39% | — | $83 – $544 |
| 9 | Wellmark fee schedule · both · +1 other terms | 13 | $192 | $192 | — | — | — | $192 – $192 |
| 10 | Bcbs Mn fee schedule · outpatient · +3 other terms | 12 | $120 | $114 | $33 | 29% | — | $62 – $150 |
| 11 | Bcbs Nj fee schedule · outpatient | 12 | $54 | $68 | $25 | 37% | — | $47 – $126 |
| 12 | Cigna facility · fee schedule · outpatient · +2 other terms | 10 | $135 | $427 | $311 | 73% | — | $29 – $1.0k |
| 13 | Aetna Better Health facility · case rate · outpatient | 7 | $104 | $104 | $2 | 2% | — | $99 – $104 |
| 14 | Amerihealth Caritas facility · case rate · outpatient · +1 other terms | 7 | $96 | $97 | $3 | 3% | — | $96 – $104 |
| 15 | Bcbs Id facility · fee schedule · outpatient · +1 other terms | 2 | $189 | $189 | $119 | 63% | — | $70 – $307 |
| 16 | Medicaid facility · case rate · outpatient | 2 | $87 | $87 | — | — | — | $87 – $87 |
| 17 | Bcbs La fee schedule · outpatient · +1 other terms | 1 | $119 | $119 | — | — | — | $119 – $119 |
| 18 | Bcbs Nc facility · fee schedule · outpatient | 1 | $166 | $166 | — | — | — | $166 – $166 |
| 19 | Bcbs Nv fee schedule · outpatient | 1 | $24 | $24 | $15 | 63% | — | $3 – $36 |
| 20 | Bcbs Vt professional · fee schedule · outpatient | 1 | $200 | $200 | $80 | 40% | — | $120 – $280 |
| 21 | Healthpartners facility · fee schedule · outpatient | 1 | $242 | $242 | — | — | — | $242 – $242 |
| 22 | Highmark fee schedule · outpatient | 1 | $245 | $245 | $102 | 42% | — | $173 – $389 |
| 23 | WellCare facility · case rate · outpatient | 1 | $87 | $87 | — | — | — | $87 – $87 |
← Hospitals reporting HCPCS G0255 · Snapshot 20261112T124536Z-e251e855