MRI upper extremity without and with contrast at St.davids Surgical Hospital

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

MRI UP EX W&WO CONT RT

Austin, TX

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Pricing by billing methodology

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How this price compares nationally

St.davids Surgical Hospital’s median price of $1.0k is 12% above the median hospital's median price ($904), higher than 54% of the 2,530 hospitals reporting CPT 73220. The highlighted bar is where this hospital falls; shaded is the middle 50% of hospitals.

Payers reporting CPT 73220 at St.davids Surgical Hospital

Negotiated rates from the hospital’s own file: 8 payers, 31 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 chip percent of total billed charges · outpatientfrom % of charges	$113	$150	$53	35%	—	$113 – $225
2	Superior Healthplan chpfc percent of total billed charges · outpatientfrom % of charges	$113	$150	$53	35%	—	$113 – $225
3	Superior Healthplan star percent of total billed charges · outpatientfrom % of charges	$113	$150	$53	35%	—	$113 – $225
4	Superior Healthplan starplus percent of total billed charges · outpatientfrom % of charges	$113	$150	$53	35%	—	$113 – $225
5	Humana mgmcd fee schedule · outpatient	$458	$458	—	—	—	$458 – $458
6	Aetna Better Health mcd fee schedule · outpatient	$462	$462	—	—	—	$462 – $462
7	Superior Healthplan ambetterepo percent of total billed charges · outpatientfrom % of charges	$383	$510	$180	35%	—	$383 – $765
8	Superior Healthplan ambetterhmo percent of total billed charges · outpatientfrom % of charges	$383	$510	$180	35%	—	$383 – $765
9	Superior Healthplan valuehmo percent of total billed charges · outpatientfrom % of charges	$383	$510	$180	35%	—	$383 – $765
10	UnitedHealthcare narrownetworkhix fee schedule · outpatient	$563	$563	—	—	—	$563 – $563
11	UnitedHealthcare optionsppo percent of total billed charges · outpatientfrom % of charges	$561	$747	$264	35%	—	$561 – $1.1k
12	UnitedHealthcare allpayerappendix fee schedule · outpatient	$828	$828	—	—	—	$828 – $828
13	UnitedHealthcare smallgroup fee schedule · outpatient	$828	$828	—	—	—	$828 – $828
14	Humana hmo percent of total billed charges · outpatientfrom % of charges	$625	$834	$295	35%	—	$625 – $1.3k
15	Humana ppo percent of total billed charges · outpatientfrom % of charges	$625	$834	$295	35%	—	$625 – $1.3k
16	Blue Cross Blue Shield mybluehealth fee schedule · outpatient	$871	$871	—	—	—	$871 – $871
17	Blue Cross Blue Shield traditional percent of total billed charges · outpatientfrom % of charges	$664	$885	$313	35%	—	$664 – $1.3k
18	Blue Cross Blue Shield blueadvantage fee schedule · outpatient	$1.1k	$1.1k	—	—	—	$1.1k – $1.1k
19	UnitedHealthcare globalbenefitplan percent of total billed charges · outpatientfrom % of charges	$1.0k	$1.4k	$478	35%	—	$1.0k – $2.0k
20	Blue Cross Blue Shield blueessentials fee schedule · outpatient	$1.5k	$1.5k	—	—	—	$1.5k – $1.5k
21	Blue Cross Blue Shield blueessentialsaccess fee schedule · outpatient	$1.5k	$1.5k	—	—	—	$1.5k – $1.5k
22	Blue Cross Blue Shield eposoa fee schedule · outpatient	$1.6k	$1.6k	—	—	—	$1.6k – $1.6k
23	Blue Cross Blue Shield ppo fee schedule · outpatient	$1.8k	$1.8k	—	—	—	$1.8k – $1.8k
24	Aetna narrownetwork per diem · outpatient	$1.9k	$1.9k	—	—	—	$1.9k – $1.9k
25	First Health ppo percent of total billed charges · outpatientfrom % of charges	$1.6k	$1.9k	$701	36%	—	$1.3k – $3.1k

Page 1 of 2 · 31 rates

Last updated: Sep 1, 2026

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