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
PR OPH SVCS MEDICAL XM&EVAL COMPRE NEW PT 1/> VST
Cedar Rapids, IA
See all hospitals reporting CPT 92004 →Price type
St Luke's Methodist Hospital’s median price of $148 is 2% above the median hospital's median price ($145), higher than 54% of the 1,426 hospitals reporting CPT 92004. The highlighted bar is where this hospital falls; shaded is the middle 50% of hospitals.
Negotiated rates from the hospital’s own file: 6 payers, 22 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 medicare advantage fee schedule · both | $86 | $86 | — | — | — | $86 – $86 |
| 2 | Molina medicare advantage fee schedule · both | $88 | $88 | — | — | — | $88 – $88 |
| 3 | Wellmark medicare advantage fee schedule · both | $88 | $88 | — | — | — | $88 – $88 |
| 4 | Humana medicare advantage fee schedule · both | $90 | $90 | — | — | — | $90 – $90 |
| 5 | UnitedHealthcare medicare advantage fee schedule · both | $90 | $90 | — | — | — | $90 – $90 |
| 6 | Aetna medicare advantage case rate · outpatient | $122 | $122 | — | — | — | $122 – $122 |
| 7 | Molina medicare advantage case rate · outpatient | $122 | $122 | — | — | — | $122 – $122 |
| 8 | Wellmark medicare advantage case rate · outpatient | $122 | $122 | — | — | — | $122 – $122 |
| 9 | Humana medicare advantage case rate · outpatient | $125 | $125 | — | — | — | $125 – $125 |
| 10 | UnitedHealthcare medicare advantage case rate · outpatient | $125 | $125 | — | — | — | $125 – $125 |
| 11 | Wellmark commercial fee schedule · both | $170 | $170 | — | — | — | $170 – $170 |
| 12 | Wellmark hmo fee schedule · both | $170 | $170 | — | — | — | $170 – $170 |
| 13 | Wellmark ppo fee schedule · both | $200 | $200 | — | — | — | $200 – $200 |
| 14 | Aetna hmo fee schedule · both | $217 | $217 | — | — | — | $217 – $217 |
| 15 | Cigna commercial fee schedule · both | $227 | $227 | — | — | — | $227 – $227 |
| 16 | Aetna hmo fee schedule · outpatient | $251 | $251 | — | — | — | $251 – $251 |
| 17 | UnitedHealthcare hmo fee schedule · both | $260 | $260 | — | — | — | $260 – $260 |
| 18 | UnitedHealthcare ppo fee schedule · both | $260 | $260 | — | — | — | $260 – $260 |
| 19 | Aetna ppo fee schedule · outpatient | $262 | $262 | — | — | — | $262 – $262 |
| 20 | Aetna ppo fee schedule · both | $264 | $264 | — | — | — | $264 – $264 |
| 21 | UnitedHealthcare hmo fee schedule · outpatient | $321 | $321 | — | — | — | $321 – $321 |
| 22 | UnitedHealthcare ppo fee schedule · outpatient | $321 | $321 | — | — | — | $321 – $321 |
Last updated: Jan 28, 2026
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