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
Abao Bfa Serial S&I
Gary, IN
See all hospitals reporting CPT 75630 →Price type
The Methodist Hospitals, Inc.’s median price of $6.2k is 91% above the median hospital's median price ($3.2k), higher than 92% of the 2,147 hospitals reporting CPT 75630. The highlighted bar is where this hospital falls; shaded is the middle 50% of hospitals.
Negotiated rates from the hospital’s own file: 10 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 | Anthem indiana hmo medicaid facility · fee schedule · outpatient | $258 | $258 | — | — | — | $258 – $258 |
| 2 | Caresource indiana hmo medicaid facility · fee schedule · outpatient | $258 | $258 | — | — | — | $258 – $258 |
| 3 | Humana indiana hmo medicaid facility · fee schedule · outpatient | $258 | $258 | — | — | — | $258 – $258 |
| 4 | UnitedHealthcare indiana hmo medicaid facility · fee schedule · outpatient | $258 | $258 | — | — | — | $258 – $258 |
| 5 | Aetna medicare advantage facility · fee schedule · outpatient | $3.3k | $3.3k | — | — | — | $3.3k – $3.3k |
| 6 | Anthem medicare advantage facility · fee schedule · outpatient | $3.3k | $3.3k | — | — | — | $3.3k – $3.3k |
| 7 | Humana medicare advantage facility · fee schedule · outpatient | $3.3k | $3.3k | — | — | — | $3.3k – $3.3k |
| 8 | Medicare medicare facility · fee schedule · outpatient | $3.3k | $3.3k | — | — | — | $3.3k – $3.3k |
| 9 | Anthem pathway essentials facility · fee schedule · outpatient | $5.0k | $5.0k | — | — | — | $5.0k – $5.0k |
| 10 | Cigna hmo facility · percent of total billed charges · outpatientfrom % of charges | $5.3k | $5.3k | — | — | — | $5.3k – $5.3k |
| 11 | Caresource caresource facility · fee schedule · outpatient | $5.5k | $5.5k | — | — | — | $5.5k – $5.5k |
| 12 | Cigna ppo facility · percent of total billed charges · outpatientfrom % of charges | $5.8k | $5.8k | — | — | — | $5.8k – $5.8k |
| 13 | UnitedHealthcare navigate and core payer facility · percent of total billed charges · outpatientfrom % of charges | $5.8k | $5.8k | — | — | — | $5.8k – $5.8k |
| 14 | UnitedHealthcare hmo_and_ppo_contracted_plans facility · percent of total billed charges · outpatientfrom % of charges | $6.2k | $6.2k | — | — | — | $6.2k – $6.2k |
| 15 | Aetna hmo_and_ppo_contracted_plans facility · fee schedule · outpatient | $6.6k | $6.6k | — | — | — | $6.6k – $6.6k |
| 16 | Ambetter ambetter healthplan facility · fee schedule · outpatient | $6.6k | $6.6k | — | — | — | $6.6k – $6.6k |
| 17 | Aetna firsthealth facility · percent of total billed charges · outpatientfrom % of charges | $8.6k | $8.6k | — | — | — | $8.6k – $8.6k |
| 18 | Anthem individual on exchange facility · fee schedule · outpatient | $8.8k | $8.8k | — | — | — | $8.8k – $8.8k |
| 19 | Phcs ppo facility · percent of total billed charges · outpatientfrom % of charges | $9.4k | $9.4k | — | — | — | $9.4k – $9.4k |
| 20 | MultiPlan ppo facility · percent of total billed charges · outpatientfrom % of charges | $10.1k | $10.1k | — | — | — | $10.1k – $10.1k |
| 21 | Aetna coventry facility · percent of total billed charges · outpatientfrom % of charges | $10.2k | $10.2k | — | — | — | $10.2k – $10.2k |
| 22 | Anthem traditonal,hmo,ppo contracted plans and individual off exchange facility · fee schedule · outpatient | $11.1k | $11.1k | — | — | — | $11.1k – $11.1k |
Last updated: Aug 18, 2026
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