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
DISK/FOAM PAD +OR- ADHESIVE
Low
$0
Average
$3
Median
$2
High
$96
Each hospital's average Cigna rate, under the methodology and billing class chosen below.
129 hospitals; the 90th percentile is 2.8× 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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129 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 | Tanner Medical Center - Carrollton Carrollton, GA facility · percent of total billed charges · outpatientfrom % of charges | 1 | $0 | $0 | — | — | 5–50 | $0 – $0 |
| 2 | ALLE-KISKI MEDICAL CENTER NATRONA HEIGHTS, PA fee schedule · outpatient | 2 | $3 | $3 | $1 | 26% | — | $2 – $3 |
| 3 | Allen Memorial Hospital Corporation Waterloo, IA fee schedule · both | 1 | $2 | $2 | — | — | — | $2 – $2 |
| 4 | Alomere Health Alexandria, MN facility · fee schedule · outpatient | 1 | $6 | $6 | — | — | — | $6 – $6 |
| 5 | BELTON REGIONAL MEDICAL CENTER Kansas City, MO fee schedule · outpatient | 1 | $2 | $2 | — | — | — | $2 – $2 |
| 6 | Blue Hill Memorial Hospital Hill, ME professional · fee schedule · outpatient | 1 | $1 | $1 | — | — | — | $1 – $1 |
| 7 | CANONSBURG GENERAL HOSPITAL CANONSBURG, PA fee schedule · outpatient | 2 | $3 | $3 | $1 | 26% | — | $2 – $3 |
| 8 | CATHOLIC HEALTH INIATIVES COLORADO Westminster, CO fee schedule · outpatient | 1 | $2 | $2 | — | — | — | $2 – $2 |
| 9 | CATHOLIC HEALTH INITIATIVES COLORADO Pueblo, CO fee schedule · outpatient | 1 | $2 | $2 | — | — | — | $2 – $2 |
| 10 | CATHOLIC HEALTH INITIATIVES COLORADO Colorado Springs, CO fee schedule · outpatient | 1 | $2 | $2 | — | — | — | $2 – $2 |
| 11 | CATHOLIC HEALTH INITIATIVES COLORADO Frisco, CO fee schedule · outpatient | 1 | $2 | $2 | — | — | — | $2 – $2 |
| 12 | CATHOLIC HEALTH INITIATIVES COLORADO Durango, CO fee schedule · outpatient | 1 | $2 | $2 | — | — | — | $2 – $2 |
| 13 | CATHOLIC HEALTH INITIATIVES COLORADO Colorado Springs, CO fee schedule · outpatient | 1 | $2 | $2 | — | — | — | $2 – $2 |
| 14 | CATHOLIC HEALTH INITIATIVES COLORADO Fort Morgan, CO fee schedule · outpatient | 1 | $2 | $2 | — | — | — | $2 – $2 |
| 15 | CENTERPOINT MEDICAL CENTER Independence, MO fee schedule · outpatient | 1 | $2 | $2 | — | — | — | $2 – $2 |
| 16 | CHRISTUS Good Shepherd Hospital - Northpark Longview, TX fee schedule · outpatient | 1 | $2 | $2 | — | — | — | $2 – $2 |
| 17 | CLOVIS COMMUNITY MEDICAL CENTER Clovis, CA facility · case rate · outpatient | 2 | $2 | $2 | — | — | — | $2 – $2 |
| 18 | COMMONSPIRIT KANSAS, INC. Dodge City, KS fee schedule · outpatient | 1 | $2 | $2 | — | — | — | $2 – $2 |
| 19 | COMMONSPIRIT KANSAS, INC. Garden City, KS fee schedule · outpatient | 1 | $2 | $2 | — | — | — | $2 – $2 |
| 20 | Central Iowa Hospital Corporation Des Moines, IA fee schedule · both | 1 | $2 | $2 | — | — | — | $2 – $2 |
| 21 | Central Iowa Hospital Corporation West Des Moines, IA fee schedule · both | 1 | $2 | $2 | — | — | — | $2 – $2 |
| 22 | Charles A. Dean Memorial Hospital Greenville, ME professional · fee schedule · outpatient | 1 | $1 | $1 | — | — | — | $1 – $1 |
| 23 | Charleston Area Medical Center Charleston, WV percent of total billed charges · bothfrom % of charges | 1 | $96 | $96 | — | — | — | $96 – $96 |
| 24 | Cheshire Medical Center Keene, NH professional · fee schedule · outpatient | 3 | $1 | $1 | $0 | 24% | — | $1 – $2 |
| 25 | ERIE COUNTY MEDICAL CENTER CORPORATION Buffalo, NY fee schedule · outpatient | 1 | $4 | $4 | — | — | — | $4 – $4 |
← Payers reporting HCPCS A5126 · Snapshot 20261111T120946Z-9134e7f7