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
Custom grad sleeve med
Low
$0
Average
$129
Median
$79
High
$484
Each payer's average rate across its hospitals, under the methodology and billing class chosen below.
19 payers; the 90th percentile is 87.4× 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 facility · fee schedule · outpatient · +4 other terms | 32 | $181 | $188 | $72 | 38% | — | $102 – $421 |
| 2 | Aetna fee schedule · outpatient · +6 other terms | 20 | $4 | $57 | $106 | 185% | — | $4 – $344 |
| 3 | Anthem facility · case rate · outpatient · +4 other terms | 15 | $10 | $11 | $3 | 23% | — | $7 – $17 |
| 4 | Caresource facility · case rate · outpatient · +1 other terms | 15 | $10 | $11 | $3 | 23% | — | $7 – $17 |
| 5 | Molina facility · case rate · outpatient · +1 other terms | 15 | $10 | $11 | $3 | 23% | — | $7 – $17 |
| 6 | UnitedHealthcare facility · case rate · outpatient · +3 other terms | 15 | $10 | $11 | $3 | 23% | — | $7 – $17 |
| 7 | Cigna facility · fee schedule · outpatient · +3 other terms | 13 | $73 | $141 | $96 | 68% | — | $73 – $484 |
| 8 | Optum facility · case rate · outpatient · +1 other terms | 11 | $10 | $10 | $2 | 22% | — | $9 – $15 |
| 9 | Highmark fee schedule · outpatient · +2 other terms | 10 | $413 | $413 | — | — | — | $413 – $413 |
| 10 | Bcbs Mn fee schedule · both · +2 other terms | 8 | $183 | $182 | $2 | 1% | — | $181 – $184 |
| 11 | Aetna Better Health fee schedule · inpatient · +1 other terms | 7 | $4 | $4 | — | — | — | $4 – $4 |
| 12 | Humana fee schedule · inpatient · +2 other terms | 5 | $4 | $4 | — | — | — | $4 – $4 |
| 13 | Bcbs Ks fee schedule · outpatient · +1 other terms | 3 | $335 | $348 | $21 | 6% | — | $332 – $377 |
| 14 | First Health professional · fee schedule · both | 3 | $4 | $4 | — | — | — | $4 – $4 |
| 15 | Bcbs La facility · fee schedule · outpatient | 1 | $0 | $0 | — | — | — | $0 – $0 |
| 16 | Bcbs Nc facility · fee schedule · outpatient | 1 | $285 | $285 | — | — | — | $285 – $285 |
| 17 | Bcbs Nv fee schedule · outpatient | 1 | $70 | $70 | — | — | — | $70 – $70 |
| 18 | Bcbs Vt professional · fee schedule · outpatient | 1 | $133 | $133 | — | — | — | $133 – $133 |
| 19 | Healthpartners facility · fee schedule · outpatient | 1 | $484 | $484 | — | — | — | $484 – $484 |
← Hospitals reporting HCPCS S8422 · Snapshot 20261112T181611Z-3fa9fb76