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
Renew ft matrix, per square centimeter (add-on, list separately in addition to primary procedure)
Low
$45
Average
$696
Median
$140
High
$9.5k
Each payer's average rate across its hospitals, under the methodology and billing class chosen below.
37 payers; the 90th percentile is 16.3× 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.
Filter by billing methodology
Filter by billing class
| # | ||||||||
|---|---|---|---|---|---|---|---|---|
| 1 | UnitedHealthcare fee schedule · outpatient · +8 other terms | 263 | $210 | $617 | $1.6k | 258% | — | $51 – $7.6k |
| 2 | Cigna fee schedule · outpatient · +5 other terms | 123 | $4.6k | $10.9k | $10.9k | 100% | — | $119 – $33.6k |
| 3 | Aetna fee schedule · outpatient · +7 other terms | 106 | $127 | $434 | $1.7k | 383% | — | $69 – $11.7k |
| 4 | Blue Cross Blue Shield fee schedule · outpatient · +4 other terms | 101 | $11 | $41 | $61 | 148% | — | $1 – $335 |
| 5 | Humana fee schedule · outpatient · +5 other terms | 67 | $125 | $127 | $13 | 10% | — | $116 – $171 |
| 6 | WellCare fee schedule · outpatient · +4 other terms | 41 | $136 | $138 | $14 | 10% | — | $119 – $171 |
| 7 | Molina facility · fee schedule · outpatient · +5 other terms | 34 | $118 | $129 | $50 | 39% | — | $65 – $319 |
| 8 | Devoted fee schedule · outpatient · +3 other terms | 32 | $125 | $124 | $7 | 6% | — | $116 – $136 |
| 9 | Optum fee schedule · outpatient · +1 other terms | 32 | $125 | $173 | $91 | 53% | — | $113 – $459 |
| 10 | Ambetter fee schedule · outpatient · +2 other terms | 30 | $240 | $255 | $38 | 15% | — | $193 – $351 |
| 11 | Anthem fee schedule · outpatient · +3 other terms | 23 | $155 | $294 | $305 | 103% | — | $123 – $911 |
| 12 | Kaiser fee schedule · outpatient · +3 other terms | 22 | $125 | $307 | $247 | 80% | — | $125 – $1000 |
| 13 | Medicare fee schedule · outpatient | 18 | $125 | $125 | — | — | — | $125 – $125 |
| 14 | Caresource facility · fee schedule · outpatient · +2 other terms | 14 | $212 | $180 | $42 | 23% | — | $121 – $238 |
| 15 | Medical Mutual facility · fee schedule · outpatient · +1 other terms | 13 | $118 | $123 | $13 | 10% | — | $118 – $167 |
| 16 | Regence fee schedule · outpatient · +4 other terms | 10 | $146 | $146 | $4 | 3% | — | $140 – $156 |
| 17 | Tricare fee schedule · outpatient · +1 other terms | 10 | $113 | $115 | $4 | 3% | — | $113 – $121 |
| 18 | Excellus fee schedule · outpatient · +2 other terms | 6 | $236 | $230 | $60 | 26% | — | $127 – $351 |
| 19 | Highmark fee schedule · outpatient · +3 other terms | 6 | $176 | $1.6k | $1.7k | 107% | — | $127 – $4.4k |
| 20 | Aetna Better Health facility · fee schedule · outpatient | 5 | $68 | $68 | $1 | 1% | — | $68 – $70 |
| 21 | Clover fee schedule · outpatient | 5 | $120 | $125 | $9 | 7% | — | $120 – $140 |
| 22 | Oscar fee schedule · outpatient · +1 other terms | 4 | $154 | $181 | $51 | 28% | — | $147 – $270 |
| 23 | First Health professional · fee schedule · both · +1 other terms | 3 | $4.3k | $4.3k | — | — | — | $4.3k – $4.3k |
| 24 | Bcbs Al facility · case rate · outpatient | 2 | $125 | $125 | — | — | — | $125 – $125 |
| 25 | Bcbs Id fee schedule · outpatient | 2 | $140 | $140 | — | — | — | $140 – $140 |
← Hospitals reporting HCPCS Q4378 · Snapshot 20261112T181611Z-3fa9fb76