Fallopian tube dye test during procedure at Holy Cross Hospital-Silver Spring

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.

Model: claude-haiku-5-5
Provider: anthropic
API: message_batches
Reasoning effort: low
Max output tokens: 4096
Prompt version (hash): 444523875572
Generated: October 20, 2026

Original text from hospital filings

PR Chromotubation Oviduct Including Materials|BILATERAL PROCEDURE|MULTIPLE PROCEDURES

Silver Spring, MD

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How this price compares nationally

Holy Cross Hospital-Silver Spring’s median price of $210 is 96% below the median hospital's median price ($5.1k), higher than 14% of the 1,835 hospitals reporting CPT 58350. The highlighted bar is where this hospital falls; shaded is the middle 50% of hospitals.

Payers reporting CPT 58350 at Holy Cross Hospital-Silver Spring

Negotiated rates from the hospital’s own file: 34 payers, 111 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	Aetna aetna medicare advantage professional · fee schedule · inpatient	$46	$46	—	—	—	$46 – $46
2	Humana tricare professional · fee schedule · inpatient	$50	$50	—	—	—	$50 – $50
3	Tricare tricare professional · fee schedule · inpatient	$50	$50	—	—	—	$50 – $50
4	Aetna aetna medicare advantage professional · fee schedule · both	$58	$58	$12	20%	—	$46 – $69
5	Humana tricare professional · fee schedule · both	$50	$59	$12	20%	—	$50 – $76
6	Tricare tricare professional · fee schedule · both	$50	$59	$12	20%	—	$50 – $76
7	Aetna aetna medicare advantage professional · fee schedule · outpatient	$69	$69	—	—	—	$69 – $69
8	Aetna aetna professional · fee schedule · inpatient	$74	$74	—	—	—	$74 – $74
9	Humana tricare professional · fee schedule · outpatient	$76	$76	—	—	—	$76 – $76
10	Tricare tricare professional · fee schedule · outpatient	$76	$76	—	—	—	$76 – $76
11	Aetna aetna professional · fee schedule · both	$92	$92	$18	20%	—	$74 – $111
12	Aetna aetna professional · fee schedule · outpatient	$111	$111	—	—	—	$111 – $111
13	Aetna pb xr 100% default professional · percent of total billed charges · inpatientfrom % of charges	$210	$210	—	—	—	$210 – $210
14	Ambetter pb xr 100% default professional · percent of total billed charges · inpatientfrom % of charges	$210	$210	—	—	—	$210 – $210
15	Amerihealth Caritas pb xr 100% default professional · percent of total billed charges · inpatientfrom % of charges	$210	$210	—	—	—	$210 – $210
16	Anthem pb xr 100% default professional · percent of total billed charges · inpatientfrom % of charges	$210	$210	—	—	—	$210 – $210
17	Blue Cross Blue Shield pb xr 100% default professional · percent of total billed charges · inpatientfrom % of charges	$210	$210	—	—	—	$210 – $210
18	Carefirst pb xr 100% default professional · percent of total billed charges · inpatientfrom % of charges	$210	$210	—	—	—	$210 – $210
19	Caresource pb xr 100% default professional · percent of total billed charges · inpatientfrom % of charges	$210	$210	—	—	—	$210 – $210
20	Cigna pb xr 100% default professional · percent of total billed charges · inpatientfrom % of charges	$210	$210	—	—	—	$210 – $210
21	Clover pb xr 100% default professional · percent of total billed charges · inpatientfrom % of charges	$210	$210	—	—	—	$210 – $210
22	Devoted pb xr 100% default professional · percent of total billed charges · inpatientfrom % of charges	$210	$210	—	—	—	$210 – $210
23	Excellus pb xr 100% default professional · percent of total billed charges · inpatientfrom % of charges	$210	$210	—	—	—	$210 – $210
24	First Health pb xr 100% default professional · percent of total billed charges · inpatientfrom % of charges	$210	$210	—	—	—	$210 – $210
25	Highmark pb xr 100% default professional · percent of total billed charges · inpatientfrom % of charges	$210	$210	—	—	—	$210 – $210

Page 1 of 5 · 111 rates

Last updated: Mar 31, 2026

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