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
Doc med rsn no tbco scrn
Low
$0
Average
$5
Median
$1
High
$11
Each payer's average rate across its hospitals, under the methodology and billing class chosen below.
11 payers; the 90th percentile is 1058.9× 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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| # | ||||||||
|---|---|---|---|---|---|---|---|---|
| 1 | Anthem facility · case rate · outpatient · +1 other terms | 15 | $10 | $11 | $2 | 23% | — | $7 – $16 |
| 2 | Caresource facility · case rate · outpatient | 15 | $10 | $11 | $2 | 23% | — | $7 – $17 |
| 3 | Molina facility · case rate · outpatient | 15 | $10 | $11 | $2 | 23% | — | $7 – $16 |
| 4 | UnitedHealthcare facility · case rate · outpatient · +1 other terms | 15 | $10 | $11 | $3 | 24% | — | $7 – $17 |
| 5 | Wellmark fee schedule · both | 13 | $1 | $1 | — | — | — | $1 – $1 |
| 6 | Optum facility · case rate · outpatient | 11 | $9 | $10 | $2 | 22% | — | $8 – $15 |
| 7 | Aetna professional · fee schedule · outpatient · +1 other terms | 2 | $0 | $0 | — | — | — | $0 – $0 |
| 8 | Aetna Better Health professional · fee schedule · both | 1 | $0 | $0 | — | — | — | $0 – $0 |
| 9 | Bcbs Vt professional · fee schedule · outpatient | 1 | $0 | $0 | — | — | — | $0 – $0 |
| 10 | Blue Cross Blue Shield fee schedule · both · +2 other terms | 1 | $0 | $0 | $0 | 33% | — | $0 – $0 |
| 11 | WellCare professional · fee schedule · both | 1 | $0 | $0 | — | — | — | $0 – $0 |
← Hospitals reporting HCPCS G9904 · Snapshot 20261113T090226Z-3ce6c0b8