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
Lso sag-coronal panel custom
Low
$411
Average
$2.0k
Median
$1.8k
High
$7.4k
Each payer's average rate across its hospitals, under the methodology and billing class chosen below.
55 payers; the 90th percentile is 2.1× 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 · +20 other terms | 398 | $1.6k | $1.8k | $916 | 50% | — | $389 – $8.0k |
| 2 | Aetna fee schedule · outpatient · +18 other terms | 373 | $1.6k | $1.9k | $903 | 47% | — | $632 – $10.6k |
| 3 | Humana fee schedule · outpatient · +19 other terms | 330 | $1.6k | $2.4k | $2.6k | 107% | — | $585 – $12.5k |
| 4 | Blue Cross Blue Shield fee schedule · outpatient · +19 other terms | 245 | $1.7k | $2.2k | $1.4k | 65% | — | $0 – $10.2k |
| 5 | WellCare fee schedule · outpatient · +11 other terms | 216 | $1.7k | $1.7k | $269 | 16% | — | $389 – $3.1k |
| 6 | Devoted fee schedule · outpatient · +4 other terms | 165 | $1.6k | $1.6k | $38 | 2% | — | $1.6k – $2.0k |
| 7 | Molina fee schedule · outpatient · +12 other terms | 151 | $2.1k | $2.2k | $858 | 39% | — | $829 – $4.3k |
| 8 | Cigna fee schedule · outpatient · +17 other terms | 126 | $1.7k | $2.3k | $1.1k | 50% | — | $635 – $6.9k |
| 9 | Cigna Healthspring fee schedule · outpatient · +1 other terms | 116 | $1.7k | $1.7k | $58 | 3% | — | $1.6k – $2.0k |
| 10 | Anthem fee schedule · outpatient · +14 other terms | 96 | $1.6k | $2.7k | $2.3k | 88% | — | $829 – $12.2k |
| 11 | Kaiser fee schedule · outpatient · +15 other terms | 84 | $1.7k | $2.5k | $1.8k | 71% | — | $764 – $11.6k |
| 12 | Caresource fee schedule · outpatient · +9 other terms | 48 | $1.6k | $1.6k | $366 | 22% | — | $822 – $2.5k |
| 13 | Clover fee schedule · outpatient · +3 other terms | 42 | $1.7k | $1.6k | $83 | 5% | — | $1.6k – $1.9k |
| 14 | Superior Healthplan fee schedule · outpatient | 40 | $1.7k | $1.7k | $8 | 0% | — | $1.6k – $1.7k |
| 15 | Ambetter facility · fee schedule · outpatient · +10 other terms | 37 | $2.9k | $3.0k | $780 | 26% | — | $1.2k – $4.1k |
| 16 | Oscar fee schedule · outpatient · +9 other terms | 36 | $1.7k | $1.9k | $399 | 21% | — | $1.6k – $2.7k |
| 17 | Optum fee schedule · outpatient · +3 other terms | 34 | $1.6k | $2.2k | $840 | 39% | — | $1.6k – $4.1k |
| 18 | Medica facility · fee schedule · outpatient · +8 other terms | 24 | $1.7k | $1.5k | $384 | 25% | — | $540 – $2.7k |
| 19 | Medicare fee schedule · outpatient · +3 other terms | 24 | $1.6k | $1.6k | $18 | 1% | — | $1.5k – $1.6k |
| 20 | MultiPlan fee schedule · outpatient · +12 other terms | 23 | $4.9k | $4.4k | $1.6k | 38% | — | $1.6k – $7.4k |
| 21 | Regence facility · fee schedule · outpatient · +5 other terms | 19 | $1.7k | $1.6k | $129 | 8% | — | $1.3k – $1.7k |
| 22 | Amerihealth Caritas fee schedule · outpatient · +5 other terms | 18 | $2.0k | $1.9k | $108 | 6% | — | $1.6k – $2.0k |
| 23 | Bcbs Tx fee schedule · outpatient | 18 | $1.6k | $1.6k | — | — | — | $1.6k – $1.6k |
| 24 | Medical Mutual facility · fee schedule · outpatient · +2 other terms | 15 | $1.6k | $1.9k | $462 | 25% | — | $882 – $2.6k |
| 25 | First Health fee schedule · outpatient · +8 other terms | 14 | $4.0k | $4.1k | $1.7k | 42% | — | $1.3k – $7.2k |
← Hospitals reporting HCPCS L0638 · Snapshot 20261112T181611Z-3fa9fb76