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-A-RFLX HERPICSF 50379
Phoenix, AZ
See all hospitals reporting CPT 86695 →Price type
Dignity Health’s median price of $15 is 35% below the median hospital's median price ($22), higher than 31% of the 2,606 hospitals reporting CPT 86695. 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, 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 | UnitedHealthcare commercial|navigate fee schedule · outpatient | $6 | $6 | — | — | — | $6 – $6 |
| 2 | UnitedHealthcare commercial|all other plans fee schedule · outpatient | $8 | $8 | — | — | — | $8 – $8 |
| 3 | UnitedHealthcare commercial|options ppo fee schedule · outpatient | $8 | $8 | — | — | — | $8 – $8 |
| 4 | Aetna medicare|all plans fee schedule · outpatient | $13 | $13 | — | — | — | $13 – $13 |
| 5 | Blue Cross Blue Shield medicare|all plans fee schedule · outpatient | $13 | $13 | — | — | — | $13 – $13 |
| 6 | Cigna medicare|all plans fee schedule · outpatient | $13 | $13 | — | — | — | $13 – $13 |
| 7 | First Health medicare|all plans fee schedule · outpatient | $13 | $13 | — | — | — | $13 – $13 |
| 8 | Humana medicare|all plans fee schedule · outpatient | $13 | $13 | — | — | — | $13 – $13 |
| 9 | Optum medicare|optumcare fee schedule · outpatient | $13 | $13 | — | — | — | $13 – $13 |
| 10 | UnitedHealthcare medicare|all other plans fee schedule · outpatient | $13 | $13 | — | — | — | $13 – $13 |
| 11 | UnitedHealthcare medicare|dual complete fee schedule · outpatient | $13 | $13 | — | — | — | $13 – $13 |
| 12 | UnitedHealthcare medicaid|all plans fee schedule · outpatient | $14 | $14 | — | — | — | $14 – $14 |
| 13 | UnitedHealthcare commercial|dignityhealthemployee fee schedule · outpatient | $14 | $14 | $1 | 10% | — | $11 – $15 |
| 14 | Optum medicare|optumhealth fee schedule · outpatient | $15 | $15 | — | — | — | $15 – $15 |
| 15 | Cigna commercial|exchange fee schedule · outpatient | $27 | $27 | — | — | — | $27 – $27 |
| 16 | Cigna commercial|localplus surefit fee schedule · outpatient | $29 | $29 | — | — | — | $29 – $29 |
| 17 | Optum commercial|optumhealth fee schedule · outpatient | $35 | $34 | $3 | 10% | — | $28 – $37 |
| 18 | Cigna commercial|all other plans fee schedule · outpatient | $39 | $39 | — | — | 4–40 | $39 – $39 |
| 19 | Cigna commercial|lifesource fee schedule · outpatient | $41 | $39 | $4 | 10% | — | $33 – $43 |
| 20 | Aetna commercial|all plans fee schedule · outpatient | $42 | $42 | — | — | 4–40 | $42 – $42 |
| 21 | First Health commercial|all plans fee schedule · inpatient | $52 | $50 | $5 | 10% | — | $42 – $55 |
| 22 | First Health commercial|all plans fee schedule · outpatient | $52 | $50 | $5 | 10% | — | $42 – $55 |
| 23 | MultiPlan commercial|all plans fee schedule · inpatient | $58 | $56 | $5 | 10% | — | $47 – $62 |
| 24 | MultiPlan commercial|all plans fee schedule · outpatient | $58 | $56 | $5 | 10% | — | $47 – $62 |
| 25 | Blue Cross Blue Shield commercial|maricopafocus fee schedule · outpatient | $59 | $59 | — | — | — | $59 – $59 |
Last updated: Feb 28, 2026
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