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
Fee Schedule
Low
$1
Average
$70
Median
$55
High
$175
Each payer's average rate across its hospitals, under the methodology and billing class chosen below.
21 payers; the 90th percentile is 4.0× 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 | Blue Cross Blue Shield fee schedule · outpatient · +3 other terms | 14 | $173 | $198 | $77 | 39% | — | $74 – $324 |
| 2 | Wellmark fee schedule · both · +1 other terms | 13 | $62 | $62 | — | — | — | $62 – $62 |
| 3 | Molina facility · case rate · outpatient · +5 other terms | 12 | $43 | $46 | $12 | 26% | — | $36 – $83 |
| 4 | Humana fee schedule · outpatient · +4 other terms | 11 | $132 | $103 | $32 | 31% | — | $49 – $144 |
| 5 | Anthem facility · fee schedule · outpatient · +4 other terms | 10 | $122 | $343 | $741 | 216% | — | $25 – $2.6k |
| 6 | Aetna Better Health facility · case rate · outpatient | 7 | $43 | $43 | $0 | 1% | — | $42 – $43 |
| 7 | Amerihealth Caritas facility · case rate · outpatient · +1 other terms | 7 | $40 | $40 | $1 | 3% | — | $40 – $43 |
| 8 | UnitedHealthcare fee schedule · outpatient · +6 other terms | 7 | $79 | $84 | $6 | 7% | — | $79 – $93 |
| 9 | Aetna facility · case rate · outpatient · +7 other terms | 6 | $42 | $48 | $16 | 32% | — | $36 – $83 |
| 10 | Medicaid facility · case rate · outpatient | 4 | $34 | $34 | $3 | 8% | — | $31 – $36 |
| 11 | Bcbs Tx facility · fee schedule · outpatient | 3 | $137 | $137 | $3 | 2% | — | $132 – $139 |
| 12 | Cigna professional · fee schedule · outpatient · +3 other terms | 2 | $38 | $37 | $2 | 4% | — | $36 – $39 |
| 13 | Medica fee schedule · outpatient · +1 other terms | 2 | $93 | $93 | — | — | — | $93 – $93 |
| 14 | Optum facility · case rate · outpatient | 2 | $34 | $34 | — | — | — | $34 – $34 |
| 15 | Ambetter professional · fee schedule · outpatient | 1 | $39 | $39 | — | — | — | $39 – $39 |
| 16 | Bcbs Vt professional · fee schedule · outpatient | 1 | $39 | $39 | — | — | — | $39 – $39 |
| 17 | Bcbs Wy fee schedule · both | 1 | $55 | $55 | — | — | — | $55 – $55 |
| 18 | First Health professional · percent of total billed charges · bothfrom % of charges | 1 | $77 | $77 | — | — | — | $77 – $77 |
| 19 | Healthpartners facility · fee schedule · outpatient | 1 | $127 | $127 | — | — | — | $127 – $127 |
| 20 | MultiPlan fee schedule · both | 1 | $1 | $1 | — | — | — | $1 – $1 |
| 21 | WellCare facility · case rate · outpatient · +1 other terms | 1 | $36 | $36 | — | — | — | $36 – $36 |
← Hospitals reporting HCPCS G2065 · Snapshot 20261112T124536Z-e251e855