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
Ntiol category 4
Low
$0
Average
$11.3k
Median
$374
High
$50k
Each payer's average rate across its hospitals, under the methodology and billing class chosen below.
13 payers; the 90th percentile is 589.9× 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 | Aetna case rate · outpatient · +3 other terms | 35 | $4.0k | $5.5k | $2.2k | 41% | — | $2.6k – $13.5k |
| 2 | Humana fee schedule · outpatient · +2 other terms | 32 | $358 | $432 | $64 | 15% | — | $358 – $487 |
| 3 | Anthem facility · case rate · outpatient · +4 other terms | 15 | $182 | $199 | $47 | 23% | — | $124 – $309 |
| 4 | Caresource facility · case rate · outpatient · +3 other terms | 15 | $185 | $199 | $46 | 23% | — | $124 – $315 |
| 5 | Molina facility · case rate · outpatient · +1 other terms | 15 | $182 | $199 | $46 | 23% | — | $128 – $309 |
| 6 | UnitedHealthcare facility · case rate · outpatient · +1 other terms | 15 | $185 | $202 | $47 | 23% | — | $128 – $315 |
| 7 | Optum facility · case rate · outpatient | 11 | $172 | $188 | $42 | 22% | — | $155 – $279 |
| 8 | Blue Cross Blue Shield other · outpatient · +2 other terms | 5 | $24.2k | $24.2k | $7.2k | 30% | — | $14.0k – $33.3k |
| 9 | Cigna other · outpatient | 5 | $26.7k | $26.8k | $9.5k | 35% | — | $7.2k – $31.5k |
| 10 | Phcs percent of total billed charges · outpatientfrom % of charges | 5 | $37.5k | $37.5k | — | — | — | $37.5k – $37.5k |
| 11 | Tricare fee schedule · outpatient | 5 | $50k | $50k | — | — | — | $50k – $50k |
| 12 | Bcbs La facility · fee schedule · outpatient | 1 | $0 | $0 | — | — | — | $0 – $0 |
| 13 | Bcbs Nv fee schedule · outpatient | 1 | $50 | $50 | — | — | — | $50 – $50 |
← Hospitals reporting HCPCS Q1004 · Snapshot 20261112T181611Z-3fa9fb76