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
RL-UB-INCUBAT-SER AND DRG
Los Angeles, CA
See all hospitals reporting CPT 86975 →Price type
Dignity Community Care’s median price of $160 is 55% below the median hospital's median price ($360), higher than 28% of the 1,577 hospitals reporting CPT 86975. 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, 29 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 | Anthem medicaid|all plans fee schedule · outpatient | $30 | $30 | — | — | — | $30 – $30 |
| 2 | Molina medicaid|< 21 fee schedule · outpatient | $33 | $33 | — | — | — | $33 – $33 |
| 3 | Molina medicaid|> 21 fee schedule · outpatient | $33 | $33 | — | — | — | $33 – $33 |
| 4 | Kaiser medicaid|< 21 fee schedule · outpatient | $36 | $36 | — | — | — | $36 – $36 |
| 5 | Kaiser medicaid|> 21 fee schedule · outpatient | $36 | $36 | — | — | — | $36 – $36 |
| 6 | Cigna commercial|all other plans fee schedule · outpatient | $63 | $63 | — | — | — | $63 – $63 |
| 7 | Cigna commercial|ppo fee schedule · outpatient | $63 | $63 | — | — | — | $63 – $63 |
| 8 | Aetna commercial|all other plans fee schedule · outpatient | $90 | $90 | — | — | — | $90 – $90 |
| 9 | Aetna commercial|hmo fee schedule · outpatient | $90 | $90 | — | — | — | $90 – $90 |
| 10 | Aetna commercial|ppo fee schedule · outpatient | $90 | $90 | — | — | — | $90 – $90 |
| 11 | Blue Cross Blue Shield commercial|exchange fee schedule · outpatient | $101 | $101 | $51 | 50% | — | $51 – $152 |
| 12 | Anthem commercial|exchange fee schedule · outpatient | $115 | $115 | — | — | — | $115 – $115 |
| 13 | Blue Cross Blue Shield medicaid|all plans fee schedule · outpatient | $119 | $119 | — | — | — | $119 – $119 |
| 14 | Anthem commercial|all other plans fee schedule · outpatient | $174 | $174 | — | — | — | $174 – $174 |
| 15 | Anthem commercial|mcs fee schedule · outpatient | $213 | $213 | $2 | 1% | — | $211 – $214 |
| 16 | UnitedHealthcare commercial|hmo fee schedule · outpatient | $268 | $268 | $57 | 21% | — | $211 – $324 |
| 17 | UnitedHealthcare commercial|ppo fee schedule · outpatient | $268 | $268 | $57 | 21% | — | $211 – $324 |
| 18 | First Health commercial|all plans fee schedule · inpatient | $292 | $292 | $146 | 50% | — | $146 – $437 |
| 19 | First Health commercial|all plans fee schedule · outpatient | $292 | $292 | $146 | 50% | — | $146 – $437 |
| 20 | Kaiser commercial|all plans fee schedule · inpatient | $296 | $296 | $148 | 50% | — | $148 – $444 |
| 21 | Kaiser commercial|all plans fee schedule · outpatient | $296 | $296 | $148 | 50% | — | $148 – $444 |
| 22 | Blue Cross Blue Shield medicare|promise fee schedule · outpatient | $317 | $317 | $159 | 50% | — | $158 – $476 |
| 23 | MultiPlan commercial|all plans fee schedule · inpatient | $334 | $334 | $167 | 50% | — | $167 – $501 |
| 24 | MultiPlan commercial|all plans fee schedule · outpatient | $334 | $334 | $167 | 50% | — | $167 – $501 |
| 25 | Aetna medicare|all plans fee schedule · outpatient | $359 | $359 | $148 | 41% | — | $211 – $507 |
Last updated: Feb 28, 2026
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