Prolotherapy injection treatment

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.

Model: claude-haiku-5-5
Provider: anthropic
API: message_batches
Reasoning effort: low
Max output tokens: 4096
Prompt version (hash): 444523875572
Generated: October 20, 2026

Original text from hospital filings

PR PROLOTHERAPY

Payers reporting HCPCS M0076

Payer pricing summary

Low

$13

Average

$224

Median

$167

High

$1.9k

Payer rate distribution

Filter by billing methodology

Filter by billing class

#
1	Aetna fee schedule · outpatient · +16 other terms	40	$96	$205	$196	96%	—	$20 – $712
2	Blue Cross Blue Shield fee schedule · outpatient · +14 other terms	32	$268	$259	$495	191%	—	$0 – $5.0k
3	Molina facility · case rate · outpatient · +12 other terms	27	$189	$187	$46	25%	—	$111 – $353
4	Humana other · outpatient · +12 other terms	25	$2.9k	$2.9k	$861	29%	—	$2.3k – $7.0k
5	UnitedHealthcare facility · case rate · outpatient · +15 other terms	19	$161	$179	$80	45%	—	$0 – $361
6	Anthem facility · case rate · outpatient · +13 other terms	15	$158	$174	$40	23%	—	$108 – $268
7	Caresource facility · case rate · outpatient · +5 other terms	15	$161	$174	$39	22%	—	$108 – $274
8	Optum facility · case rate · outpatient · +7 other terms	13	$151	$163	$33	20%	—	$135 – $243
9	Oscar facility · percent of total billed charges · inpatientfrom % of charges · +5 other terms	13	$141	$216	$175	81%	—	$141 – $627
10	Wellmark fee schedule · both · +5 other terms	13	$208	$205	$18	9%	—	$94 – $208
11	Medicaid fee schedule · outpatient · +1 other terms	12	$163	$168	$108	65%	—	$75 – $683
12	Sanford Health Plan facility · percent of total billed charges · inpatientfrom % of charges · +4 other terms	11	$50	$129	$240	186%	—	$28 – $846
13	Cigna professional · fee schedule · outpatient · +13 other terms	10	$5	$21	$32	151%	—	$5 – $92
14	Medical Mutual facility · percent of total billed charges · outpatientfrom % of charges · +3 other terms	10	$69	$72	$23	32%	—	$34 – $113
15	Medica facility · percent of total billed charges · inpatientfrom % of charges · +3 other terms	9	$87	$85	$29	34%	—	$49 – $122
16	Bcbs Mn fee schedule · both · +2 other terms	8	$283	$283	$3	1%	—	$281 – $286
17	First Health professional · fee schedule · both · +8 other terms	8	$0	$29	$37	129%	—	$0 – $77
18	Medcost professional · percent of total billed charges · outpatientfrom % of charges · +1 other terms	8	$199	$279	$128	46%	—	$194 – $563
19	Aetna Better Health fee schedule · inpatient · +6 other terms	7	$72	$72	—	—	—	$72 – $72
20	Amerihealth Caritas facility · case rate · outpatient · +2 other terms	7	$175	$177	$6	3%	—	$175 – $191
21	Ucare professional · percent of total billed charges · outpatientfrom % of charges · +2 other terms	6	$205	$254	$63	25%	—	$180 – $350
22	Bcbs Il professional · fee schedule · both	5	$0	$13	$33	245%	—	$0 – $94
23	Kaiser fee schedule · outpatient · +3 other terms	5	$198	$229	$115	50%	—	$138 – $523
24	Medicare facility · percent of total billed charges · outpatientfrom % of charges	5	$22	$23	$2	7%	—	$22 – $26
25	WellCare professional · fee schedule · both · +3 other terms	5	$0	$0	—	—	—	$0 – $0

Page 1 of 2 · 36 payers