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
Calibrated microcap tube
Low
$1
Average
$158
Median
$1
High
$1.5k
Each hospital's average Cigna rate, under the methodology and billing class chosen below.
14 hospitals; the 90th percentile is 940.7× 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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14 hospital rates
iThe hospitals that file a Cigna 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 | Blue Hill Memorial Hospital Hill, ME professional · fee schedule · outpatient | 1 | $1 | $1 | — | — | — | $1 – $1 |
| 2 | Charles A. Dean Memorial Hospital Greenville, ME professional · fee schedule · outpatient | 1 | $1 | $1 | — | — | — | $1 – $1 |
| 3 | Cheshire Medical Center Keene, NH professional · fee schedule · outpatient | 2 | $1 | $1 | — | — | — | $1 – $1 |
| 4 | Children's Hospital of Philadelphia, The Philadelphia, PA percent of total billed charges · outpatientfrom % of charges | 2 | $417 | $1.5k | $2.1k | 136% | — | $7 – $6.5k |
| 5 | Eastern Maine Medical Center Bangor, ME professional · fee schedule · outpatient | 1 | $1 | $1 | — | — | — | $1 – $1 |
| 6 | Maine Coast Regional Health Facilities Ellsworth, ME professional · fee schedule · outpatient | 1 | $1 | $1 | — | — | — | $1 – $1 |
| 7 | Mary Hitchcock Memorial Hospital Lebanon, NH professional · fee schedule · outpatient | 2 | $2 | $2 | — | — | — | $2 – $2 |
| 8 | Mayo Regional Hospital Dover Foxcroft, ME professional · fee schedule · outpatient | 1 | $1 | $1 | — | — | — | $1 – $1 |
| 9 | Memorial Hospital of Laramie County Cheyenne, WY fee schedule · both | 1 | $3 | $3 | — | — | — | $3 – $3 |
| 10 | Mercy Hospital Portland, ME professional · fee schedule · outpatient | 1 | $1 | $1 | — | — | — | $1 – $1 |
| 11 | Sebasticook Valley Health Pittsfield, ME professional · fee schedule · outpatient | 1 | $1 | $1 | — | — | — | $1 – $1 |
| 12 | The Aroostook Medical Center Isle, ME professional · fee schedule · outpatient | 1 | $1 | $1 | — | — | — | $1 – $1 |
| 13 | The University of Tennessee Medical Center Knoxville, TN facility · percent of total billed charges · outpatientfrom % of charges | 3 | $522 | $662 | $198 | 30% | — | $522 – $942 |
| 14 | The University of Texas Medical Branch Webster, TX percent of total billed charges · bothfrom % of charges | 1 | $23 | $23 | — | — | — | $23 – $23 |
← Payers reporting HCPCS A4651 · Snapshot 20261112T124536Z-e251e855