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
HC ANRCT MANO RCT SNSATN & BALO
Low
$343
Average
$381
Median
$386
High
$397
Each hospital's average Cigna Healthspring rate, under the methodology and billing class chosen below.
11 hospitals; the 90th percentile is 1.1× the 10th. Each bar is a price range and its height is how many hospitals fall in it. Hover a bar, or a row in the ladder, for details.
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11 hospital rates
iThe hospitals that file a Cigna Healthspring rate for this code, one row per hospital and set of terms (billing class, payment method, setting). Rates under different terms are never blended, so the terms are shown under each hospital’s name. Figures are the hospital’s averages across its plans.| # | Plans | |||||||
|---|---|---|---|---|---|---|---|---|
| 1 | Affinity Hospital LLC Birmingham, AL facility · fee schedule · outpatient | 1 | $343 | $343 | — | — | — | $343 – $343 |
| 2 | Holy Redeemer Health System Meadowbrook, PA facility · case rate · outpatient | 1 | $397 | $397 | — | — | — | $397 – $397 |
| 3 | Northwest Hospital LLC Tucson, AZ facility · fee schedule · outpatient | 1 | $392 | $392 | — | — | — | $392 – $392 |
| 4 | Northwest Sahurita Hospital LLC Tucson, AZ facility · fee schedule · outpatient | 1 | $392 | $392 | — | — | — | $392 – $392 |
| 5 | Northwest Sahurita Hospital LLC Sahuarita, AZ facility · fee schedule · outpatient | 1 | $392 | $392 | — | — | — | $392 – $392 |
| 6 | Oro Valley Hospital LLC Tucson, AZ facility · fee schedule · outpatient | 1 | $392 | $392 | — | — | — | $392 – $392 |
| 7 | USA Health University Hospital Mobile, AL facility · case rate · outpatient | 1 | $347 | $347 | — | — | — | $347 – $347 |
| 8 | University of Virginia Culpeper Medical Center Culpeper, VA other · both | 1 | $386 | $386 | — | — | — | $386 – $386 |
| 9 | University of Virginia Haymarket Medical Center Haymarket, VA other · both | 1 | $386 | $386 | — | — | — | $386 – $386 |
| 10 | University of Virginia Medical Center Charlottesville, VA other · both | 1 | $374 | $374 | — | — | — | $374 – $374 |
| 11 | University of Virginia Prince William Medical Center Manassas, VA other · both | 1 | $386 | $386 | — | — | — | $386 – $386 |
← Payers reporting CPT 91125 · Snapshot 20261112T181611Z-3fa9fb76