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
Hi inten serv for sip model
Low
$0
Average
$76
Median
$72
High
$271
Each payer's average rate across its hospitals, under the methodology and billing class chosen below.
15 payers; the 90th percentile is 13.9× 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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Filter by billing class
| # | ||||||||
|---|---|---|---|---|---|---|---|---|
| 1 | Molina facility · case rate · outpatient · +4 other terms | 29 | $34 | $61 | $43 | 70% | — | $14 – $182 |
| 2 | UnitedHealthcare facility · case rate · outpatient · +4 other terms | 17 | $21 | $32 | $24 | 74% | — | $14 – $88 |
| 3 | Anthem facility · case rate · outpatient · +5 other terms | 15 | $20 | $22 | $5 | 23% | — | $13 – $34 |
| 4 | Caresource facility · case rate · outpatient · +1 other terms | 15 | $20 | $22 | $5 | 23% | — | $13 – $34 |
| 5 | Optum facility · case rate · outpatient | 13 | $19 | $29 | $20 | 70% | — | $17 – $76 |
| 6 | Blue Cross Blue Shield fee schedule · outpatient · +2 other terms | 8 | $2 | $8 | $19 | 254% | — | $0 – $87 |
| 7 | Humana facility · case rate · outpatient · +2 other terms | 8 | $80 | $83 | $4 | 5% | — | $80 – $88 |
| 8 | Aetna Better Health facility · case rate · outpatient | 7 | $96 | $95 | $1 | 1% | — | $92 – $96 |
| 9 | Amerihealth Caritas facility · case rate · outpatient · +1 other terms | 7 | $88 | $89 | $3 | 3% | — | $88 – $96 |
| 10 | Aetna facility · case rate · outpatient · +2 other terms | 5 | $96 | $111 | $35 | 31% | — | $80 – $182 |
| 11 | Wellmark facility · case rate · outpatient | 3 | $309 | $271 | $85 | 32% | — | $126 – $341 |
| 12 | Medicaid facility · case rate · outpatient | 2 | $80 | $80 | — | — | — | $80 – $80 |
| 13 | Bcbs Id professional · fee schedule · outpatient | 1 | $1 | $1 | — | — | — | $1 – $1 |
| 14 | Bcbs La fee schedule · outpatient · +1 other terms | 1 | $0 | $0 | — | — | — | $0 – $0 |
| 15 | WellCare facility · case rate · outpatient | 1 | $80 | $80 | — | — | — | $80 – $80 |
← Hospitals reporting HCPCS G2020 · Snapshot 20261112T181611Z-3fa9fb76