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
US NRV&ACC STRUX 1XTR COMPRE
Burnet, TX
See all hospitals reporting CPT 76883 →Price type
Ascension Seton’s median price of $122 is 3% above the median hospital's median price ($119), higher than 51% of the 1,527 hospitals reporting CPT 76883. The highlighted bar is where this hospital falls; shaded is the middle 50% of hospitals.
Negotiated rates from the hospital’s own file: 4 payers, 22 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 | Ambetter 3880_superior ambetter (chi,dcn) outpatient 20240901 fee schedule · outpatient | $58 | $58 | — | — | — | $58 – $58 |
| 2 | Blue Cross Blue Shield 4168_blue cross chip (chi,dcn) outpatient 20241201 fee schedule · outpatient | $58 | $58 | — | — | — | $58 – $58 |
| 3 | Blue Cross Blue Shield 4168_blue cross chip/star kids (chi,dcn) outpatient 20241201 fee schedule · outpatient | $58 | $58 | — | — | — | $58 – $58 |
| 4 | Blue Cross Blue Shield 4219_chirp blue cross star (chi,dcn) outpatient 20241201 fee schedule · outpatient | $58 | $58 | — | — | — | $58 – $58 |
| 5 | Blue Cross Blue Shield 5003_blue cross star kids (chi,dcn) outpatient 20241201 fee schedule · outpatient | $58 | $58 | — | — | — | $58 – $58 |
| 6 | Superior Healthplan 4246_chirp superior star (shl) outpatient 20241201 fee schedule · outpatient | $58 | $58 | — | — | — | $58 – $58 |
| 7 | Superior Healthplan 4399_chirp superior star plus (shl) outpatient 20241201 fee schedule · outpatient | $58 | $58 | — | — | — | $58 – $58 |
| 8 | UnitedHealthcare 4253_chirp uhc star (chi,dcn) outpatient 20241201 fee schedule · outpatient | $58 | $58 | — | — | — | $58 – $58 |
| 9 | UnitedHealthcare 4264_chirp uhc star plus (chi,dcn) outpatient 20241201 fee schedule · outpatient | $58 | $58 | — | — | — | $58 – $58 |
| 10 | UnitedHealthcare 4311_uhc star kids (chi,dcn) outpatient 20241201 fee schedule · outpatient | $58 | $58 | — | — | — | $58 – $58 |
| 11 | Blue Cross Blue Shield 4127_blue cross blue shield bav exchange 20250101 fee schedule · outpatient | $107 | $107 | — | — | — | $107 – $107 |
| 12 | Blue Cross Blue Shield 4173_blue cross chip (shl) outpatient 20241201 fee schedule · outpatient | $137 | $137 | — | — | — | $137 – $137 |
| 13 | Blue Cross Blue Shield 4173_blue cross chip/star kids (shl) outpatient 20241201 fee schedule · outpatient | $137 | $137 | — | — | — | $137 – $137 |
| 14 | Blue Cross Blue Shield 4224_chirp blue cross star (shl) outpatient 20241201 fee schedule · outpatient | $137 | $137 | — | — | — | $137 – $137 |
| 15 | Blue Cross Blue Shield 5013_blue cross star kids (shl) outpatient 20241201 fee schedule · outpatient | $137 | $137 | — | — | — | $137 – $137 |
| 16 | UnitedHealthcare 4258_chirp uhc star (shl) outpatient 20241201 fee schedule · outpatient | $137 | $137 | — | — | — | $137 – $137 |
| 17 | UnitedHealthcare 4269_chirp uhc star plus (shl) outpatient 20241201 fee schedule · outpatient | $137 | $137 | — | — | — | $137 – $137 |
| 18 | UnitedHealthcare 4316_uhc star kids (shl) outpatient 20241201 fee schedule · outpatient | $137 | $137 | — | — | — | $137 – $137 |
| 19 | Blue Cross Blue Shield 4440_blue cross blue shield hpn 20250501 fee schedule · outpatient | $355 | $355 | — | — | — | $355 – $355 |
| 20 | Blue Cross Blue Shield 4497_blue cross blue shield hpn (dell, williamson,hays) 20250501 fee schedule · outpatient | $355 | $355 | — | — | — | $355 – $355 |
| 21 | Blue Cross Blue Shield 4095_blue cross blue shield hmo essentials 20250101 fee schedule · outpatient | $392 | $392 | — | — | — | $392 – $392 |
| 22 | Blue Cross Blue Shield 4094_blue cross blue shield ppo 20250101 fee schedule · outpatient | $433 | $433 | — | — | — | $433 – $433 |
Last updated: Jan 1, 2026
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