Fee Schedule

Payers reporting HCPCS G2058

Payer pricing summary

Low

$25

Average

$76

Median

$68

High

$198

Payer rate distribution

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#
1	Wellmark fee schedule · both · +3 other terms	13	$44	$44	—	—	—	$44 – $44
2	Molina facility · case rate · outpatient · +5 other terms	12	$43	$46	$12	26%	—	$36 – $83
3	Humana fee schedule · outpatient · +5 other terms	11	$98	$81	$23	28%	—	$36 – $106
4	Anthem facility · fee schedule · outpatient · +4 other terms	10	$119	$262	$518	198%	—	$25 – $1.8k
5	Aetna Better Health facility · case rate · outpatient	7	$43	$43	$0	1%	—	$42 – $43
6	Amerihealth Caritas facility · case rate · outpatient · +1 other terms	7	$40	$40	$1	3%	—	$40 – $43
7	Blue Cross Blue Shield fee schedule · outpatient · +2 other terms	7	$118	$108	$27	25%	—	$60 – $148
8	UnitedHealthcare fee schedule · outpatient · +7 other terms	6	$79	$82	$5	6%	—	$79 – $89
9	Aetna facility · case rate · outpatient · +8 other terms	5	$43	$50	$16	32%	—	$36 – $83
10	Bcbs La other · outpatient · +1 other terms	3	$41	$37	$7	20%	—	$27 – $43
11	Optum other · outpatient · +1 other terms	3	$82	$65	$27	42%	—	$27 – $86
12	Medica fee schedule · outpatient	2	$81	$81	$6	8%	—	$74 – $89
13	Medicaid facility · case rate · outpatient	2	$36	$36	—	—	—	$36 – $36
14	MultiPlan other · outpatient · +3 other terms	2	$59	$59	$10	17%	—	$49 – $69
15	Cigna fee schedule · both · +3 other terms	1	$34	$34	$3	9%	—	$31 – $37
16	First Health other · outpatient · +2 other terms	1	$66	$66	—	—	—	$66 – $66
17	Healthpartners facility · fee schedule · outpatient	1	$121	$121	—	—	—	$121 – $121
18	Magellan professional · percent of total billed charges · outpatientfrom % of charges	1	$95	$95	—	—	—	$95 – $95
19	Tricare percent of total billed charges · outpatientfrom % of charges	1	$25	$25	$1	5%	—	$24 – $27
20	WellCare facility · case rate · outpatient	1	$36	$36	—	—	—	$36 – $36

← Hospitals reporting HCPCS G2058 · Snapshot 20261112T124536Z-e251e855