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
NJX AA&/STRD GNCLR NRV BRNCH
Waco, TX
See all hospitals reporting CPT 64454 →Price type
Ascension Providence’s median price of $140 is 84% below the median hospital's median price ($902), higher than 4% of the 2,066 hospitals reporting CPT 64454. The highlighted bar is where this hospital falls; shaded is the middle 50% of hospitals.
Negotiated rates from the hospital’s own file: 8 payers, 21 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 872_blue cross blue shield myblueheath 20250101 fee schedule · outpatient | $126 | $126 | — | — | — | $126 – $126 |
| 2 | Blue Cross Blue Shield 975_bcbs star outpatient 20241201 fee schedule · outpatient | $140 | $140 | — | — | — | $140 – $140 |
| 3 | Molina 908_molina chip outpatient 20241201 fee schedule · outpatient | $140 | $140 | — | — | — | $140 – $140 |
| 4 | Superior Healthplan 904_superior star outpatient 20241201 fee schedule · outpatient | $140 | $140 | — | — | — | $140 – $140 |
| 5 | Superior Healthplan 907_superior star plus outpatient 20241201 fee schedule · outpatient | $140 | $140 | — | — | — | $140 – $140 |
| 6 | UnitedHealthcare 906_uhc star plus outpatient 20241201 fee schedule · outpatient | $140 | $140 | — | — | — | $140 – $140 |
| 7 | UnitedHealthcare 909_uhc star kids outpatient 20241201 fee schedule · outpatient | $140 | $140 | — | — | — | $140 – $140 |
| 8 | UnitedHealthcare 928_uhc star outpatient 20250701 fee schedule · outpatient | $140 | $140 | — | — | — | $140 – $140 |
| 9 | Blue Cross Blue Shield 871_blue cross blue shield advantage hmo 20250101 fee schedule · outpatient | $158 | $158 | — | — | — | $158 – $158 |
| 10 | Blue Cross Blue Shield 870_blue cross blue shield hmo essentials 20250101 fee schedule · outpatient | $269 | $269 | — | — | — | $269 – $269 |
| 11 | Blue Cross Blue Shield 869_blue cross blue shield ppo 20250101 fee schedule · outpatient | $299 | $299 | — | — | — | $299 – $299 |
| 12 | Tricare 877_tricare outpatient 20250101 other · outpatient | $679 | $679 | — | — | — | $679 – $679 |
| 13 | Tricare 986_tricare inpatient 20251001 other · inpatient | $679 | $679 | — | — | — | $679 – $679 |
| 14 | WellCare 918_wellcare allwell medicare advantage outpatient 20250101 other · outpatient | $679 | $679 | — | — | — | $679 – $679 |
| 15 | WellCare 994_wellcare allwell medicare advantage inpatient 20251001 other · inpatient | $679 | $679 | — | — | — | $679 – $679 |
| 16 | Aetna 880_medicare advantage aetna outpatient 20250101 other · outpatient | $692 | $692 | — | — | — | $692 – $692 |
| 17 | Aetna 989_medicare advantage aetna inpatient 20251001 other · inpatient | $692 | $692 | — | — | — | $692 – $692 |
| 18 | UnitedHealthcare 883_medicare advantage united healthcare outpatient 20250101 other · outpatient | $692 | $692 | — | — | — | $692 – $692 |
| 19 | UnitedHealthcare 991_medicare advantage united healthcare inpatient 20251001 other · inpatient | $692 | $692 | — | — | — | $692 – $692 |
| 20 | Ambetter 876_superior ambetter outpatient 20250101 other · outpatient | $1.0k | $1.0k | — | — | — | $1.0k – $1.0k |
| 21 | Ambetter 985_superior ambetter inpatient 20251001 other · inpatient | $1.0k | $1.0k | — | — | — | $1.0k – $1.0k |
Last updated: Jan 1, 2026
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