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
HB Tlso 2mod Symphis-Xipho Pre
Low
$278
Average
$1.4k
Median
$1.2k
High
$4.9k
Each payer's average rate across its hospitals, under the methodology and billing class chosen below.
54 payers; the 90th percentile is 2.2× 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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| # | ||||||||
|---|---|---|---|---|---|---|---|---|
| 1 | UnitedHealthcare fee schedule · outpatient · +16 other terms | 372 | $1.1k | $1.1k | $266 | 24% | — | $404 – $3.5k |
| 2 | Aetna fee schedule · outpatient · +16 other terms | 361 | $1.1k | $1.3k | $586 | 46% | — | $549 – $7.2k |
| 3 | Humana fee schedule · outpatient · +16 other terms | 319 | $1.1k | $1.6k | $1.8k | 107% | — | $547 – $8.5k |
| 4 | Blue Cross Blue Shield fee schedule · outpatient · +14 other terms | 230 | $1.1k | $1.4k | $737 | 52% | — | $0 – $5.3k |
| 5 | WellCare fee schedule · outpatient · +7 other terms | 208 | $1.1k | $1.2k | $174 | 15% | — | $1.0k – $2.1k |
| 6 | Devoted fee schedule · outpatient · +4 other terms | 165 | $1.1k | $1.1k | $26 | 2% | — | $1.1k – $1.3k |
| 7 | Molina fee schedule · outpatient · +10 other terms | 141 | $1.6k | $1.5k | $583 | 39% | — | $404 – $2.9k |
| 8 | Cigna Healthspring fee schedule · outpatient · +1 other terms | 116 | $1.1k | $1.1k | $39 | 3% | — | $1.1k – $1.3k |
| 9 | Cigna fee schedule · outpatient · +15 other terms | 107 | $1.1k | $1.2k | $344 | 28% | — | $655 – $3.2k |
| 10 | Anthem fee schedule · outpatient · +11 other terms | 83 | $1.1k | $1.5k | $1.4k | 96% | — | $547 – $8.2k |
| 11 | Kaiser fee schedule · outpatient · +9 other terms | 66 | $1.1k | $1.7k | $1.2k | 71% | — | $628 – $7.9k |
| 12 | Caresource fee schedule · outpatient · +6 other terms | 40 | $1.1k | $1.1k | $277 | 26% | — | $547 – $1.7k |
| 13 | Superior Healthplan fee schedule · outpatient · +1 other terms | 40 | $1.2k | $1.2k | $6 | 0% | — | $1.1k – $1.2k |
| 14 | Clover fee schedule · outpatient · +2 other terms | 37 | $1.1k | $1.1k | $59 | 5% | — | $1.0k – $1.3k |
| 15 | Oscar fee schedule · outpatient · +3 other terms | 36 | $1.2k | $1.3k | $270 | 21% | — | $1.1k – $1.9k |
| 16 | Ambetter facility · fee schedule · outpatient · +6 other terms | 34 | $2.0k | $2.1k | $497 | 24% | — | $1.0k – $2.8k |
| 17 | Optum fee schedule · outpatient · +3 other terms | 33 | $1.1k | $1.4k | $583 | 41% | — | $1.1k – $2.8k |
| 18 | Medica facility · fee schedule · outpatient · +5 other terms | 22 | $1.1k | $1.0k | $268 | 26% | — | $365 – $1.8k |
| 19 | Amerihealth Caritas fee schedule · outpatient · +2 other terms | 18 | $1.3k | $1.3k | $73 | 6% | — | $1.1k – $1.3k |
| 20 | Bcbs Tx fee schedule · outpatient | 18 | $1.1k | $1.1k | — | — | — | $1.1k – $1.1k |
| 21 | Medicare fee schedule · outpatient · +1 other terms | 18 | $1.1k | $1.1k | $8 | 1% | — | $1.1k – $1.1k |
| 22 | Regence facility · fee schedule · outpatient · +6 other terms | 17 | $1.2k | $1.1k | $84 | 8% | — | $891 – $1.2k |
| 23 | Medical Mutual facility · fee schedule · outpatient · +1 other terms | 15 | $1.1k | $1.3k | $312 | 25% | — | $597 – $1.7k |
| 24 | Bcbs Mn fee schedule · outpatient · +6 other terms | 13 | $997 | $996 | $233 | 23% | — | $485 – $1.2k |
| 25 | Wellmark fee schedule · both · +2 other terms | 13 | $1.0k | $1.0k | $40 | 4% | — | $798 – $1.0k |
← Hospitals reporting HCPCS L0458 · Snapshot 20261111T120946Z-9134e7f7