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
DESTROY PREMAL LESIONS 15/>
Arlington, TX
See all hospitals reporting CPT 17004 →Price type
AMH Cath Labs LLC’s median price of $417 is 8% below the median hospital's median price ($452), higher than 42% of the 1,860 hospitals reporting CPT 17004. The highlighted bar is where this hospital falls; shaded is the middle 50% of hospitals.
Negotiated rates from the hospital’s own file: 6 payers, 19 plan rates. A facility fee, a professional fee, a per diem and a case rate are different bills, so each is listed on its own. Open a payer to see it across hospitals.
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| # | |||||||
|---|---|---|---|---|---|---|---|
| 1 | Blue Cross Blue Shield managed medicaid fee schedule · outpatient | $97 | $97 | — | — | — | $97 – $97 |
| 2 | UnitedHealthcare managed medicaid fee schedule · outpatient | $97 | $97 | — | — | — | $97 – $97 |
| 3 | WellCare managed medicaid fee schedule · outpatient | $102 | $102 | — | — | — | $102 – $102 |
| 4 | Molina managed medicaid fee schedule · outpatient | $105 | $105 | — | — | — | $105 – $105 |
| 5 | Aetna managed medicaid fee schedule · outpatient | $107 | $107 | — | — | — | $107 – $107 |
| 6 | Blue Cross Blue Shield exchange case rate · outpatient | $124 | $124 | — | — | — | $124 – $124 |
| 7 | Blue Cross Blue Shield hmo case rate · outpatient | $254 | $254 | — | — | — | $254 – $254 |
| 8 | Blue Cross Blue Shield ppo case rate · outpatient | $282 | $282 | — | — | — | $282 – $282 |
| 9 | Blue Cross Blue Shield medicare advantage case rate · outpatient | $409 | $409 | — | — | — | $409 – $409 |
| 10 | Humana medicare advantage case rate · outpatient | $425 | $425 | — | — | — | $425 – $425 |
| 11 | Humana medicare advantage ppo case rate · outpatient | $425 | $425 | — | — | — | $425 – $425 |
| 12 | Molina medicare advantage case rate · outpatient | $429 | $429 | — | — | — | $429 – $429 |
| 13 | WellCare medicare advantage hmo case rate · outpatient | $429 | $429 | — | — | — | $429 – $429 |
| 14 | WellCare medicare advantage mmp case rate · outpatient | $450 | $450 | — | — | — | $450 – $450 |
| 15 | UnitedHealthcare medicare advantage ppo case rate · outpatient | $454 | $454 | — | — | — | $454 – $454 |
| 16 | UnitedHealthcare medicare advantage hmo case rate · outpatient | $462 | $462 | — | — | — | $462 – $462 |
| 17 | Blue Cross Blue Shield traditional case rate · outpatient | $902 | $902 | — | — | — | $902 – $902 |
| 18 | UnitedHealthcare all payer case rate · outpatient | $1.2k | $1.2k | — | — | — | $1.2k – $1.2k |
| 19 | UnitedHealthcare ppo case rate · outpatient | $1.6k | $1.6k | — | — | — | $1.6k – $1.6k |
Last updated: Apr 21, 2026
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