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
HC REF MAYO SKETC KETONE QL, U
Irving, TX
See all hospitals reporting CPT 81003 →Price type
Baylor Scott & White Medical Center - Irving’s median price of $5 is 13% above the median hospital's median price ($5), higher than 52% of the 2,610 hospitals reporting CPT 81003. The highlighted bar is where this hospital falls; shaded is the middle 50% of hospitals.
Negotiated rates from the hospital’s own file: 9 payers, 28 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 | Superior Healthplan medicaid facility · fee schedule · outpatient | $1.89 | $1.89 | $1.89 – $1.89 |
| 2 | UnitedHealthcare medicaid/chip facility · fee schedule · outpatient | $2.02 | $2.02 | $2.02 – $2.02 |
| 3 | Baylor Scott White Health Plan medicare advantage facility · fee schedule · outpatient | $2.14 | $2.14 | $2.14 – $2.14 |
| 4 | Aetna medicare advantage facility · fee schedule · outpatient | $2.25 | $2.25 | $2.25 – $2.25 |
| 5 | Humana medicare facility · fee schedule · outpatient | $2.25 | $2.25 | $2.25 – $2.25 |
| 6 | Blue Cross Blue Shield medicare advantage facility · fee schedule · outpatient | $2.36 | $2.36 | $2.36 – $2.36 |
| 7 | Superior Healthplan medicare facility · fee schedule · outpatient | $2.36 | $2.36 | $2.36 – $2.36 |
| 8 | UnitedHealthcare medicare advantage facility · fee schedule · outpatient | $2.52 | $2.52 | $2.52 – $2.52 |
| 9 | Baylor Scott White Health Plan bsw premier - small group facility · fee schedule · outpatient | $2.70 | $2.70 | $2.70 – $2.70 |
| 10 | Baylor Scott White Health Plan bsw premier - individual facility · fee schedule · outpatient | $2.82 | $2.82 | $2.82 – $2.82 |
| 11 | Baylor Scott White Health Plan bsw premier - large group/bsw premier direct to employer (rate 1)/bswh employee facility · fee schedule · outpatient | $3.06 | $3.06 | $3.06 – $3.06 |
| 12 | Baylor Scott White Health Plan bsw plus - large group/bsw premier direct to employer (rate 2) facility · fee schedule · outpatient | $3.60 | $3.60 | $3.60 – $3.60 |
| 13 | Baylor Scott White Health Plan bsw plus - small group facility · fee schedule · outpatient | $3.71 | $3.71 | $3.71 – $3.71 |
| 14 | Ambetter ambetter exchange facility · fee schedule · outpatient | $4.84 | $4.84 | $4.84 – $4.84 |
| 15 | Blue Cross Blue Shield blue advantage facility · fee schedule · outpatient | $5.49 | $5.49 | $5.49 – $5.49 |
| 16 | Blue Cross Blue Shield blue premier/high performance network/my bluehealth facility · fee schedule · outpatient | $7.79 | $7.79 | $7.79 – $7.79 |
| 17 | UnitedHealthcare charter facility · fee schedule · outpatient | $10.00 | $10.00 | $10.00 – $10.00 |
| 18 | UnitedHealthcare nexus facility · fee schedule · outpatient | $10.00 | $10.00 | $10.00 – $10.00 |
| 19 | Blue Cross Blue Shield city of dallas facility · fee schedule · outpatient | $10.44 | $10.44 | $10.44 – $10.44 |
| 20 | UnitedHealthcare commercial broad facility · fee schedule · outpatient | $11.00 | $11.00 | $11.00 – $11.00 |
| 21 | Blue Cross Blue Shield blue essentials (hmo) facility · fee schedule · outpatient | $11.03 | $11.03 | $11.03 – $11.03 |
| 22 | Blue Cross Blue Shield bluechoice (ppo) facility · fee schedule · outpatient | $11.61 | $11.61 | $11.61 – $11.61 |
| 23 | Cigna local plus facility · percent of total billed charges · outpatientfrom % of charges | $41.20 | $47.52 | $41.20 – $79.13 |
| 24 | Aetna commercial facility · percent of total billed charges · outpatientfrom % of charges | $45.97 | $53.02 | $45.97 – $88.28 |
| 25 | Cigna hmo/ppo facility · percent of total billed charges · outpatientfrom % of charges | $48.48 | $55.92 | $48.48 – $93.09 |
Last updated: Jun 29, 2026
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