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
INS/RPLC SPI NPG/RCVR POCKET
Luling, TX
See all hospitals reporting CPT 63685 →Price type
Ascension Seton’s median price of $19.5k is 17% below the median hospital's median price ($23.7k), higher than 43% of the 1,845 hospitals reporting CPT 63685. The highlighted bar is where this hospital falls; shaded is the middle 50% of hospitals.
Negotiated rates from the hospital’s own file: 5 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 | Humana 206_humana hmo custom 20140201 other · outpatient | $969 | $969 | — | — | — | $969 – $969 |
| 2 | Oscar 4511_oscar health plan 20251001 other · both | $1k | $1k | — | — | — | $1k – $1k |
| 3 | Blue Cross Blue Shield 4168_blue cross chip (chi,dcn) outpatient 20241201 fee schedule · outpatient | $19.5k | $19.5k | — | — | — | $19.5k – $19.5k |
| 4 | Blue Cross Blue Shield 4168_blue cross chip/star kids (chi,dcn) outpatient 20241201 fee schedule · outpatient | $19.5k | $19.5k | — | — | — | $19.5k – $19.5k |
| 5 | Blue Cross Blue Shield 4170_blue cross chip (ebd) outpatient 20241201 fee schedule · outpatient | $19.5k | $19.5k | — | — | — | $19.5k – $19.5k |
| 6 | Blue Cross Blue Shield 4170_blue cross chip/star kids (ebd) outpatient 20241201 fee schedule · outpatient | $19.5k | $19.5k | — | — | — | $19.5k – $19.5k |
| 7 | Blue Cross Blue Shield 4219_chirp blue cross star (chi,dcn) outpatient 20241201 fee schedule · outpatient | $19.5k | $19.5k | — | — | — | $19.5k – $19.5k |
| 8 | Blue Cross Blue Shield 4221_chirp blue cross star (ebd) outpatient 20241201 fee schedule · outpatient | $19.5k | $19.5k | — | — | — | $19.5k – $19.5k |
| 9 | Blue Cross Blue Shield 5003_blue cross star kids (chi,dcn) outpatient 20241201 fee schedule · outpatient | $19.5k | $19.5k | — | — | — | $19.5k – $19.5k |
| 10 | Blue Cross Blue Shield 5007_blue cross star kids (ebd) outpatient 20241201 fee schedule · outpatient | $19.5k | $19.5k | — | — | — | $19.5k – $19.5k |
| 11 | UnitedHealthcare 4253_chirp uhc star (chi,dcn) outpatient 20241201 fee schedule · outpatient | $19.5k | $19.5k | — | — | — | $19.5k – $19.5k |
| 12 | UnitedHealthcare 4255_chirp uhc star (ebd) outpatient 20241201 fee schedule · outpatient | $19.5k | $19.5k | — | — | — | $19.5k – $19.5k |
| 13 | UnitedHealthcare 4264_chirp uhc star plus (chi,dcn) outpatient 20241201 fee schedule · outpatient | $19.5k | $19.5k | — | — | — | $19.5k – $19.5k |
| 14 | UnitedHealthcare 4266_chirp uhc star plus (ebd) outpatient 20241201 fee schedule · outpatient | $19.5k | $19.5k | — | — | — | $19.5k – $19.5k |
| 15 | UnitedHealthcare 4311_uhc star kids (chi,dcn) outpatient 20241201 fee schedule · outpatient | $19.5k | $19.5k | — | — | — | $19.5k – $19.5k |
| 16 | UnitedHealthcare 4313_uhc star kids (ebd) outpatient 20241201 fee schedule · outpatient | $19.5k | $19.5k | — | — | — | $19.5k – $19.5k |
| 17 | Blue Cross Blue Shield 4127_blue cross blue shield bav exchange 20250101 fee schedule · outpatient | $21.0k | $21.0k | — | — | — | $21.0k – $21.0k |
| 18 | Tricare 1229_tricare cah outpatient 20170101 case rate · outpatient | $25.8k | $25.8k | — | — | — | $25.8k – $25.8k |
| 19 | Blue Cross Blue Shield 4440_blue cross blue shield hpn 20250501 fee schedule · outpatient | $28.0k | $28.0k | — | — | — | $28.0k – $28.0k |
| 20 | Blue Cross Blue Shield 4497_blue cross blue shield hpn (dell, williamson,hays) 20250501 fee schedule · outpatient | $28.0k | $28.0k | — | — | — | $28.0k – $28.0k |
| 21 | Blue Cross Blue Shield 4095_blue cross blue shield hmo essentials 20250101 fee schedule · outpatient | $30.0k | $30.0k | — | — | — | $30.0k – $30.0k |
| 22 | Blue Cross Blue Shield 4094_blue cross blue shield ppo 20250101 fee schedule · outpatient | $34.1k | $34.1k | — | — | — | $34.1k – $34.1k |
Last updated: Jan 1, 2026
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