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
Fee Schedule
Low
$1
Average
$12
Median
$5
High
$69
Each payer's average rate across its hospitals, under the methodology and billing class chosen below.
37 payers; the 90th percentile is 29.8× 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 | Blue Cross Blue Shield fee schedule · outpatient · +11 other terms | 51 | $1 | $2 | $3 | 110% | — | $0 – $9 |
| 2 | Humana fee schedule · outpatient · +8 other terms | 41 | $7 | $7 | $3 | 44% | — | $1 – $10 |
| 3 | Anthem facility · fee schedule · outpatient · +8 other terms | 17 | $1 | $1 | $2 | 107% | — | $1 – $9 |
| 4 | Cigna fee schedule · both · +10 other terms | 17 | $1 | $4 | $10 | 251% | — | $1 – $35 |
| 5 | UnitedHealthcare facility · case rate · outpatient · +11 other terms | 16 | $49 | $52 | $12 | 23% | — | $33 – $82 |
| 6 | Caresource facility · case rate · outpatient · +4 other terms | 15 | $48 | $52 | $12 | 23% | — | $32 – $82 |
| 7 | Molina facility · case rate · outpatient · +4 other terms | 15 | $47 | $52 | $12 | 23% | — | $33 – $80 |
| 8 | Optum facility · case rate · outpatient · +3 other terms | 11 | $45 | $49 | $11 | 22% | — | $40 – $73 |
| 9 | Aetna facility · fee schedule · outpatient · +11 other terms | 10 | $2 | $1 | $1 | 37% | — | $1 – $2 |
| 10 | Superior Healthplan percent of total billed charges · outpatientfrom % of charges | 8 | $2 | $3 | $3 | 93% | — | $1 – $11 |
| 11 | Bcbs Mn fee schedule · outpatient · +1 other terms | 7 | $1 | $1 | $0 | 33% | — | $1 – $1 |
| 12 | Ambetter other · outpatient · +1 other terms | 6 | $3 | $3 | $0 | 11% | — | $2 – $3 |
| 13 | Bcbs Ms other · outpatient · +1 other terms | 5 | $4 | $4 | $0 | 4% | — | $4 – $4 |
| 14 | Cigna Healthspring other · outpatient | 5 | $3 | $3 | $0 | 12% | — | $2 – $3 |
| 15 | Tricare facility · fee schedule · outpatient · +1 other terms | 5 | $9 | $9 | $6 | 75% | — | $2 – $23 |
| 16 | WellCare other · outpatient · +2 other terms | 5 | $3 | $3 | $0 | 12% | — | $2 – $3 |
| 17 | First Health facility · fee schedule · outpatient · +4 other terms | 4 | $2 | $2 | — | — | — | $2 – $2 |
| 18 | Medical Mutual professional · fee schedule · outpatient · +3 other terms | 4 | $4 | $4 | $1 | 25% | — | $3 – $6 |
| 19 | Bcbs Tx facility · fee schedule · outpatient | 3 | $1 | $1 | $0 | 2% | — | $1 – $1 |
| 20 | Highmark facility · fee schedule · outpatient · +1 other terms | 3 | $1 | $1 | $0 | 4% | — | $1 – $1 |
| 21 | Phcs facility · percent of total billed charges · outpatientfrom % of charges · +3 other terms | 3 | $6 | $8 | $3 | 36% | — | $6 – $12 |
| 22 | Sanford Health Plan fee schedule · outpatient · +3 other terms | 3 | $1 | $1 | — | — | — | $1 – $1 |
| 23 | Aetna Better Health facility · fee schedule · outpatient · +1 other terms | 2 | $9 | $9 | — | — | — | $9 – $9 |
| 24 | Amerihealth Caritas professional · fee schedule · outpatient · +1 other terms | 2 | $1 | $1 | — | — | — | $1 – $1 |
| 25 | Kaiser fee schedule · both | 2 | $2 | $2 | — | — | — | $2 – $2 |
← Hospitals reporting HCPCS S0171 · Snapshot 20261112T181611Z-3fa9fb76