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
TEAR FILM IMG UNI/BI W/I&R
Kyle, TX
See all hospitals reporting CPT 0330T →Price type
Ascension Seton’s median price of $38 is 7% below the median hospital's median price ($41), higher than 21% of the 992 hospitals reporting CPT 0330T. 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, 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 | Tricare 1229_tricare cah outpatient 20170101 fee schedule · outpatient | $29 | $29 | — | — | — | $29 – $29 |
| 2 | Blue Cross Blue Shield 4127_blue cross blue shield bav exchange 20250101 fee schedule · outpatient | $33 | $33 | — | — | — | $33 – $33 |
| 3 | Aetna 4659_medicare advantage aetna inpatient 20251001 other · inpatient | $38 | $38 | — | — | — | $38 – $38 |
| 4 | Aetna 4749_medicare advantage aetna outpatient 20250811 other · outpatient | $38 | $38 | — | — | — | $38 – $38 |
| 5 | Devoted 4684_medicare advantage devoted health inpatient 20251001 other · inpatient | $38 | $38 | — | — | — | $38 – $38 |
| 6 | Devoted 4918_medicare advantage devoted health outpatient 20250811 other · outpatient | $38 | $38 | — | — | — | $38 – $38 |
| 7 | Humana 4661_medicare advantage humana inpatient (aus,hay,nw,sw) 20251001 other · inpatient | $38 | $38 | — | — | — | $38 – $38 |
| 8 | Humana 4921_medicare advantage humana outpatient (aus,hay,nw,sw.smv) 20250811 other · outpatient | $38 | $38 | — | — | — | $38 – $38 |
| 9 | Tricare 4696_tricare inpatient 20251001 other · inpatient | $38 | $38 | — | — | — | $38 – $38 |
| 10 | WellCare 4691_medicare advantage wellcare inpatient 20251001 other · inpatient | $38 | $38 | — | — | — | $38 – $38 |
| 11 | WellCare 4929_medicare advantage wellcare outpatient 20250811 other · outpatient | $38 | $38 | — | — | — | $38 – $38 |
| 12 | UnitedHealthcare 4687_medicare advantage united healthcare inpatient (aus,nw,sw,hay) 20251001 other · inpatient | $39 | $39 | — | — | — | $39 – $39 |
| 13 | UnitedHealthcare 4928_medicare advantage united healthcare outpatient (aus,nw,sw,hay,smv) 20250811 other · outpatient | $39 | $39 | — | — | — | $39 – $39 |
| 14 | Ambetter 4652_superior ambetter inpatient 20251001 other · inpatient | $68 | $68 | — | — | — | $68 – $68 |
| 15 | Ambetter 4960_superior ambetter outpatient 20250811 other · outpatient | $68 | $68 | — | — | — | $68 – $68 |
| 16 | Blue Cross Blue Shield 4440_blue cross blue shield hpn 20250501 fee schedule · outpatient | $111 | $111 | — | — | — | $111 – $111 |
| 17 | Blue Cross Blue Shield 4497_blue cross blue shield hpn (dell, williamson,hays) 20250501 fee schedule · outpatient | $111 | $111 | — | — | — | $111 – $111 |
| 18 | Blue Cross Blue Shield 4095_blue cross blue shield hmo essentials 20250101 fee schedule · outpatient | $123 | $123 | — | — | — | $123 – $123 |
| 19 | Blue Cross Blue Shield 4094_blue cross blue shield ppo 20250101 fee schedule · outpatient | $135 | $135 | — | — | — | $135 – $135 |
Last updated: Jan 1, 2026
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