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
Non-adju cgm supply allow
Low
$0
Average
$341
Median
$281
High
$947
Each hospital's average Blue Cross Blue Shield rate, under the methodology and billing class chosen below.
238 hospitals; the 90th percentile is 1.8× 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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251 hospital rates
iThe hospitals that file a Blue Cross Blue Shield 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 | ALBANY MEDICAL CENTER HOSPITAL Albany, NY facility · fee schedule · outpatient | 1 | $268 | $268 | — | — | — | $268 – $268 |
| 2 | AMH Cath Labs LLC Arlington, TX case rate · outpatient | 1 | $273 | $273 | — | — | — | $273 – $273 |
| 3 | Alomere Health Alexandria, MN facility · fee schedule · outpatient | 2 | $312 | $312 | — | — | — | $312 – $312 |
| 4 | Altru Hospital Grand Forks, ND facility · fee schedule · outpatient | 2 | $312 | $312 | — | — | — | $312 – $312 |
| 5 | Altru Hospital Devils Lake Devils Lake, ND facility · fee schedule · outpatient | 2 | $312 | $312 | — | — | — | $312 – $312 |
| 6 | BELTON REGIONAL MEDICAL CENTER Kansas City, MO fee schedule · outpatient | 3 | $271 | $271 | $1 | 0% | — | $271 – $273 |
| 7 | Benson Hospital Corporation Benson, AZ facility · fee schedule · outpatient | 1 | $289 | $289 | — | — | — | $289 – $289 |
| 8 | Beth Israel Deaconess Hospital - Needham Needham, MA fee schedule · outpatient | 1 | $429 | $429 | — | — | — | $429 – $429 |
| 9 | Beth Israel Deaconess Hospital - Plymouth Plymouth, MA fee schedule · outpatient | 2 | $440 | $440 | $12 | 3% | — | $428 – $452 |
| 10 | Beth Israel Deaconess Hospital-Milton Inc Milton, MA fee schedule · outpatient | 1 | $332 | $332 | — | — | — | $332 – $332 |
| 11 | Beth Israel Deaconess Medical Center Boston, MA fee schedule · outpatient | 2 | $547 | $547 | $12 | 2% | — | $535 – $559 |
| 12 | Bexar County Hospital District San Antonio, TX fee schedule · outpatient | 1 | $273 | $273 | — | — | — | $273 – $273 |
| 13 | CENTERPOINT MEDICAL CENTER Independence, MO fee schedule · outpatient | 3 | $271 | $271 | $1 | 0% | — | $271 – $273 |
| 14 | CHRISTUS Good Shepherd Hospital - Northpark Longview, TX fee schedule · outpatient | 1 | $268 | $268 | — | — | — | $268 – $268 |
| 15 | CLOVIS COMMUNITY MEDICAL CENTER Clovis, CA facility · case rate · outpatient | 1 | $273 | $273 | — | — | — | $273 – $273 |
| 16 | CLOVIS COMMUNITY MEDICAL CENTER Clovis, CA facility · fee schedule · outpatient | 1 | $528 | $528 | — | — | — | $528 – $528 |
| 17 | COLUMBIA MEMORIAL HOSPITAL Hudson, NY facility · fee schedule · outpatient | 1 | $461 | $461 | — | — | — | $461 – $461 |
| 18 | Carle BroMenn Medical Center Normal, IL case rate · outpatient | 1 | $273 | $273 | — | — | — | $273 – $273 |
| 19 | Covenant Medical Center Lubbock, TX fee schedule · outpatient | 4 | $341 | $345 | $6 | 2% | — | $341 – $356 |
| 20 | Covenant Medical Center Inc Saginaw, MI facility · fee schedule · outpatient | 1 | $869 | $869 | — | — | — | $869 – $869 |
| 21 | Covenant Medical Center Inc Saginaw, MI facility · fee schedule · outpatient | 1 | $869 | $869 | — | — | — | $869 – $869 |
| 22 | Edward Hospital Plainfield, IL fee schedule · outpatient | 1 | $426 | $426 | — | — | — | $426 – $426 |
| 23 | Elmhurst Memorial Hospital Elmhurst, IL fee schedule · outpatient | 1 | $426 | $426 | — | — | — | $426 – $426 |
| 24 | Endeavor Health Clinical Operations Skokie, IL fee schedule · outpatient | 3 | $676 | $678 | $45 | 7% | — | $624 – $735 |
| 25 | Essentia Health Duluth Duluth, MN facility · fee schedule · outpatient | 1 | $249 | $249 | — | — | — | $249 – $249 |
← Payers reporting HCPCS A4239 · Snapshot 20261111T120946Z-9134e7f7