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
LIVER DS ALYS 3 BMRK SRM ALG
Austin, TX
See all hospitals reporting CPT 81517 →Price type
Ascension Seton’s median price of $176 is 6% below the median hospital's median price ($187), higher than 7% of the 1,663 hospitals reporting CPT 81517. 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, 18 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 | Aetna 4659_medicare advantage aetna inpatient 20251001 other · inpatient | $176 | $176 | — | — | — | $176 – $176 |
| 2 | Aetna 4749_medicare advantage aetna outpatient 20250811 other · outpatient | $176 | $176 | — | — | — | $176 – $176 |
| 3 | Devoted 4684_medicare advantage devoted health inpatient 20251001 other · inpatient | $176 | $176 | — | — | — | $176 – $176 |
| 4 | Devoted 4918_medicare advantage devoted health outpatient 20250811 other · outpatient | $176 | $176 | — | — | — | $176 – $176 |
| 5 | Humana 4661_medicare advantage humana inpatient (aus,hay,nw,sw) 20251001 other · inpatient | $176 | $176 | — | — | — | $176 – $176 |
| 6 | Humana 4921_medicare advantage humana outpatient (aus,hay,nw,sw.smv) 20250811 other · outpatient | $176 | $176 | — | — | — | $176 – $176 |
| 7 | Tricare 4696_tricare inpatient 20251001 other · inpatient | $176 | $176 | — | — | — | $176 – $176 |
| 8 | WellCare 4691_medicare advantage wellcare inpatient 20251001 other · inpatient | $176 | $176 | — | — | — | $176 – $176 |
| 9 | WellCare 4929_medicare advantage wellcare outpatient 20250811 other · outpatient | $176 | $176 | — | — | — | $176 – $176 |
| 10 | UnitedHealthcare 4687_medicare advantage united healthcare inpatient (aus,nw,sw,hay) 20251001 other · inpatient | $180 | $180 | — | — | — | $180 – $180 |
| 11 | UnitedHealthcare 4928_medicare advantage united healthcare outpatient (aus,nw,sw,hay,smv) 20250811 other · outpatient | $180 | $180 | — | — | — | $180 – $180 |
| 12 | Ambetter 4652_superior ambetter inpatient 20251001 other · inpatient | $317 | $317 | — | — | — | $317 – $317 |
| 13 | Ambetter 4960_superior ambetter outpatient 20250811 other · outpatient | $317 | $317 | — | — | — | $317 – $317 |
| 14 | Blue Cross Blue Shield 4127_blue cross blue shield bav exchange 20250101 fee schedule · outpatient | $956 | $956 | — | — | — | $956 – $956 |
| 15 | Blue Cross Blue Shield 4440_blue cross blue shield hpn 20250501 fee schedule · outpatient | $1.9k | $1.9k | — | — | — | $1.9k – $1.9k |
| 16 | Blue Cross Blue Shield 4497_blue cross blue shield hpn (dell, williamson,hays) 20250501 fee schedule · outpatient | $1.9k | $1.9k | — | — | — | $1.9k – $1.9k |
| 17 | Blue Cross Blue Shield 4095_blue cross blue shield hmo essentials 20250101 fee schedule · outpatient | $2.1k | $2.1k | — | — | — | $2.1k – $2.1k |
| 18 | Blue Cross Blue Shield 4094_blue cross blue shield ppo 20250101 fee schedule · outpatient | $2.4k | $2.4k | — | — | — | $2.4k – $2.4k |
Last updated: Jan 1, 2026
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