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
PATIENT TRIAL KIT - NOVI AND MONTAGE SAFE
Low
$0
Average
$7.3k
Median
$5.9k
High
$47.7k
Each payer's average rate across its hospitals, under the methodology and billing class chosen below.
65 payers; the 90th percentile is 3.8× the 10th. Each bar is a price range and its height is how many payers fall in it. Hover a bar, or a row in the ladder, for details.
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| # | ||||||||
|---|---|---|---|---|---|---|---|---|
| 1 | Wellmark case rate · outpatient · +10 other terms | 3 | $15.9k | $15.7k | $1.2k | 7% | 45–90 | $9.6k – $16.0k |
| 2 | Blue Cross Blue Shield fee schedule · outpatient · +24 other terms | 58 | $7.1k | $7.0k | $7.3k | 104% | 42–420 | $0 – $67.3k |
| 3 | Bcbs Nj percent of total billed charges · outpatientfrom % of charges · +2 other terms | 13 | $3.5k | $4.1k | $1.8k | 43% | 16–160 | $328 – $11.9k |
| 4 | UnitedHealthcare fee schedule · outpatient · +23 other terms | 111 | $5.4k | $6.8k | $8.5k | 126% | 12–120 | $0 – $81.2k |
| 5 | Cigna Healthspring other · outpatient · +3 other terms | 6 | $3.8k | $3.7k | $4.1k | 110% | 10–100 | $140 – $32.7k |
| 6 | Bcbs Il percent of total billed charges · bothfrom % of charges · +2 other terms | 5 | $8.3k | $8.6k | $5.4k | 63% | 3–30 | $317 – $36.3k |
| 7 | MultiPlan fee schedule · outpatient · +15 other terms | 84 | $11.2k | $13.5k | $14.7k | 109% | — | $0 – $78.7k |
| 8 | Cigna fee schedule · outpatient · +23 other terms | 68 | $9.7k | $11.2k | $10.9k | 97% | — | $0 – $73.5k |
| 9 | Aetna fee schedule · inpatient · +24 other terms | 63 | $11.6k | $9.9k | $10.1k | 102% | — | $0 – $77.9k |
| 10 | Humana fee schedule · outpatient · +18 other terms | 46 | $4.4k | $11.1k | $11.2k | 101% | — | $0 – $68.2k |
| 11 | Medcost percent of total billed charges · bothfrom % of charges · +5 other terms | 44 | $10.7k | $10.3k | $8.8k | 85% | — | $0 – $181.5k |
| 12 | Kaiser fee schedule · outpatient · +14 other terms | 35 | $10.4k | $10.5k | $14.2k | 135% | — | $0 – $132.5k |
| 13 | Anthem fee schedule · outpatient · +19 other terms | 34 | $8.1k | $9.1k | $12.5k | 137% | — | $25 – $80.4k |
| 14 | First Health fee schedule · outpatient · +14 other terms | 33 | $13.2k | $16.2k | $14.0k | 86% | — | $1 – $81.3k |
| 15 | Molina fee schedule · outpatient · +18 other terms | 28 | $3.2k | $3.6k | $4.2k | 116% | — | $0 – $21.8k |
| 16 | Baylor Scott White Health Plan facility · percent of total billed charges · inpatientfrom % of charges · +1 other terms | 26 | $6.9k | $6.2k | $5.0k | 81% | — | — – $23.8k |
| 17 | Medicaid fee schedule · outpatient · +8 other terms | 26 | $11.7k | $7.5k | $15.3k | 202% | — | $1 – $132.5k |
| 18 | Amerihealth Caritas other · outpatient · +7 other terms | 25 | $2.1k | $2.5k | $5.2k | 208% | — | $1 – $89.7k |
| 19 | Phcs fee schedule · inpatient · +11 other terms | 25 | $20.2k | $15.3k | $14.4k | 94% | — | $28 – $68.2k |
| 20 | Ucare facility · percent of total billed charges · outpatientfrom % of charges · +4 other terms | 24 | $3.8k | $2.3k | $2.1k | 90% | — | $33 – $12.5k |
| 21 | Healthcare Highways percent of total billed charges · outpatientfrom % of charges · +3 other terms | 22 | $19.6k | $19.7k | $17.7k | 90% | — | $0 – $144.1k |
| 22 | Beechstreet percent of total billed charges · outpatientfrom % of charges · +3 other terms | 20 | $2.6k | $5.0k | $11.2k | 223% | — | $0 – $197.8k |
| 23 | Aetna Better Health other · outpatient · +7 other terms | 19 | $1.7k | $2.2k | $4.3k | 196% | — | $1 – $89.7k |
| 24 | Ambetter other · outpatient · +11 other terms | 19 | $35.4k | $47.2k | $60.6k | 128% | — | $142 – $226.4k |
| 25 | Medica fee schedule · outpatient · +9 other terms | 19 | $7.2k | $7.5k | $10.5k | 141% | — | $14 – $65.3k |
← Hospitals reporting HCPCS C1778 · Snapshot 20261111T120946Z-9134e7f7