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
$11.3k
Median
$4.7k
High
$95.1k
Each hospital's average Ambetter rate, under the methodology and billing class chosen below.
136 hospitals; the 90th percentile is 23.3× 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.
Filter by billing methodology
Filter by billing class
158 hospital rates
iThe hospitals that file a Ambetter 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 | Vanderbilt University Medical Center Nashville, TN percent of total billed charges · bothfrom % of charges | 2 | $3.5k | $4.7k | $5.2k | 111% | 120–1,200 | $480 – $42.3k |
| 2 | STATE OF MISSISSIPPI-UNIVERSITY OF MISSISSIPPI MEDICAL CENTER JACKSON, MS percent of total billed charges · outpatientfrom % of charges | 1 | $14.9k | $14.9k | $11.0k | 74% | 11 | $3.9k – $25.8k |
| 3 | STATE OF MISSISSIPPI-UNIVERSITY OF MISSISSIPPI MEDICAL CENTER CANTON, MS percent of total billed charges · outpatientfrom % of charges | 1 | $14.9k | $14.9k | $11.0k | 74% | 2–20 | $3.9k – $25.8k |
| 4 | Alleghany County Memorial Hospital, Inc Sparta, NC facility · percent of total billed charges · outpatientfrom % of charges | 1 | $680 | $921 | $842 | 91% | — | $14 – $3.4k |
| 5 | Atrium Health Hospitals Inc Kings Mountain, NC percent of total billed charges · outpatientfrom % of charges | 2 | $719 | $972 | $923 | 95% | — | $13 – $4.2k |
| 6 | Atrium Health Hospitals Inc Lincolnton, NC percent of total billed charges · inpatientfrom % of charges | 2 | $744 | $1.0k | $955 | 95% | — | $13 – $4.3k |
| 7 | Atrium Health Hospitals Inc Lincolnton, NC percent of total billed charges · outpatientfrom % of charges | 2 | $736 | $996 | $946 | 95% | — | $13 – $4.3k |
| 8 | Atrium Health Hospitals Inc Wadesboro, NC percent of total billed charges · inpatientfrom % of charges | 2 | $719 | $985 | $937 | 95% | — | $13 – $4.3k |
| 9 | Atrium Health Hospitals Inc Wadesboro, NC percent of total billed charges · outpatientfrom % of charges | 2 | $688 | $966 | $922 | 95% | — | $12 – $4.3k |
| 10 | BAPTIST HEALTHCARE SYSTEM INC Elizabethtown, KY other · outpatient | 2 | $74.9k | $90.1k | $60.5k | 67% | — | $904 – $214.5k |
| 11 | BAPTIST HEALTHCARE SYSTEM INC Albany, IN other · outpatient | 1 | $58.3k | $70.2k | $47.1k | 67% | — | $704 – $167.1k |
| 12 | BAPTIST HEALTHCARE SYSTEM INC Corbin, KY other · outpatient | 2 | $74.9k | $90.1k | $60.5k | 67% | — | $904 – $214.5k |
| 13 | BAPTIST HEALTHCARE SYSTEM INC Lexington, KY other · outpatient | 2 | $79.1k | $95.1k | $63.8k | 67% | — | $954 – $226.4k |
| 14 | BAPTIST HEALTHCARE SYSTEM INC Richmond, KY other · outpatient | 2 | $74.9k | $90.1k | $60.5k | 67% | — | $904 – $214.5k |
| 15 | BAPTIST HEALTHCARE SYSTEM INC Grange, KY other · outpatient | 2 | $74.9k | $90.1k | $60.5k | 67% | — | $904 – $214.5k |
| 16 | BAPTIST HEALTHCARE SYSTEM INC Paducah, KY other · outpatient | 2 | $74.9k | $90.1k | $60.5k | 67% | — | $904 – $214.5k |
| 17 | BAPTIST HEALTHCARE SYSTEM INC. Louisville, KY other · outpatient | 2 | $74.9k | $90.1k | $60.5k | 67% | — | $904 – $214.5k |
| 18 | BURLESON ST. JOSEPH HEALTH CENTER OF CALDWELL, TEXAS Caldwell, TX fee schedule · outpatient | 1 | $9.6k | $9.9k | $6.0k | 61% | — | $90 – $22.5k |
| 19 | Bartow Regional Medical Center Bartow, FL facility · percent of total billed charges · inpatientfrom % of charges | 2 | $5.7k | $11.5k | $11.1k | 97% | — | $190 – $35.3k |
| 20 | Bartow Regional Medical Center Bartow, FL facility · percent of total billed charges · outpatientfrom % of charges | 2 | $5.7k | $11.5k | $11.1k | 97% | — | $190 – $35.3k |
| 21 | Baycare Hospital Wesley Chapel Chapel, FL facility · percent of total billed charges · inpatientfrom % of charges | 2 | $5.7k | $11.5k | $11.1k | 97% | — | $190 – $35.3k |
| 22 | Baycare Hospital Wesley Chapel Chapel, FL facility · percent of total billed charges · outpatientfrom % of charges | 2 | $5.7k | $11.5k | $11.1k | 97% | — | $190 – $35.3k |
| 23 | Baylor Scott & White All Saints Medical Center - Fort Worth Fort Worth, TX facility · percent of total billed charges · outpatientfrom % of charges | 1 | $5.7k | $7.0k | $5.5k | 79% | — | $0 – $22.1k |
| 24 | Baylor Scott & White Heart and Vascular Hospital - Dallas Dallas, TX facility · percent of total billed charges · outpatientfrom % of charges | 1 | $5.7k | $7.0k | $5.5k | 79% | — | $0 – $22.1k |
| 25 | Baylor Scott & White Medical Center - Centennial Frisco, TX facility · percent of total billed charges · outpatientfrom % of charges | 1 | $5.7k | $7.0k | $5.5k | 79% | — | $0 – $22.1k |
← Payers reporting HCPCS C1778 · Snapshot 20261111T120946Z-9134e7f7