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
$7.4k
Median
$5.9k
High
$92.7k
Each hospital's average Blue Cross Blue Shield rate, under the methodology and billing class chosen below.
723 hospitals; the 90th percentile is 15.3× 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.
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957 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 | Mayo Clinic Health System Mankato 56001-4752 facility · percent of total billed charges · bothfrom % of charges | 6 | $2.0k | $4.1k | $8.1k | 197% | 340–3,400 | $51 – $58.2k |
| 2 | Mayo Clinic Rochester, MN facility · percent of total billed charges · bothfrom % of charges | 10 | $1.1k | $3.2k | $7.1k | 223% | 271–2,035 | $12 – $58.2k |
| 3 | Mayo Clinic Arizona Phoenix, AZ facility · percent of total billed charges · bothfrom % of charges | 5 | $1.9k | $3.7k | $6.8k | 184% | 255–2,163 | $45 – $60k |
| 4 | Duke University Hospital Durham, NC facility · percent of total billed charges · outpatientfrom % of charges | 2 | $6.3k | $6.3k | $3.8k | 60% | 194–1,940 | $181 – $27.1k |
| 5 | Duke University Hospital Raleigh, NC facility · percent of total billed charges · outpatientfrom % of charges | 2 | $6.3k | $6.3k | $3.8k | 60% | 194–1,940 | $181 – $27.1k |
| 6 | Mayo Clinic Health System Eau Claire 54703-5270 facility · percent of total billed charges · bothfrom % of charges | 5 | $1.7k | $3.8k | $8.0k | 209% | 185–1,706 | $12 – $58.8k |
| 7 | Holy Cross Hospital-Silver Spring Silver Spring, MD facility · percent of total billed charges · bothfrom % of charges | 1 | $4.4k | $5.7k | $6.6k | 115% | 134–1,340 | $51 – $48.6k |
| 8 | Barnes Jewish Hospital St. Louis, MO percent of total billed charges · bothfrom % of charges | 6 | $5.2k | $8.4k | $10.2k | 122% | 107–1,070 | $79 – $67.0k |
| 9 | Piedmont Eastside Snellville, GA percent of total billed charges · bothfrom % of charges | 2 | $5.4k | $6.9k | $4.6k | 67% | 102–1,020 | $126 – $21.2k |
| 10 | Stony Brook University Hospital Stony Brook, NY facility · percent of total billed charges · outpatientfrom % of charges | 1 | $4.7k | $4.7k | $613 | 13% | 92–920 | $4.1k – $5.3k |
| 11 | Saint Luke’s of Garnett Garnett, KS percent of total billed charges · bothfrom % of charges | 5 | $1.8k | $2.3k | $1.7k | 73% | 75–750 | $238 – $13.4k |
| 12 | Pitt County Memorial Hospital, Inc. Greenville, NC percent of total billed charges · bothfrom % of charges | 3 | $3.9k | $5.0k | $4.4k | 89% | 74–740 | $0 – $20.2k |
| 13 | Pitt County Memorial Hospital, Inc. Washington, NC percent of total billed charges · bothfrom % of charges | 3 | $3.9k | $5.0k | $4.4k | 89% | 74–740 | $0 – $20.2k |
| 14 | Saint Alphonsus Regional Medical Center - Boise Boise, ID facility · percent of total billed charges · bothfrom % of charges | 2 | $2.9k | $3.8k | $3.2k | 83% | 67–670 | $92 – $14.7k |
| 15 | St. Lukes Hospital of Kansas City City, KS percent of total billed charges · bothfrom % of charges | 22 | $981 | $1.2k | $605 | 52% | 63–522 | $265 – $3.4k |
| 16 | Saint Alphonsus Medical Center - Nampa Nampa, ID facility · percent of total billed charges · bothfrom % of charges | 2 | $2.9k | $3.9k | $3.2k | 83% | 62–620 | $92 – $14.7k |
| 17 | St Peters Hospital Albany, NY facility · percent of total billed charges · bothfrom % of charges | 2 | $2.0k | $2.6k | $2.3k | 90% | 58–580 | $40 – $9.8k |
| 18 | EATON RAPIDS MEDICAL CENTER Eaton Rapids, MI percent of total billed charges · outpatientfrom % of charges | 3 | $3.2k | $4.1k | $4.0k | 96% | 56–560 | $94 – $19.8k |
| 19 | Piedmont Athens Regional Athens, GA percent of total billed charges · bothfrom % of charges | 2 | $5.4k | $6.9k | $4.6k | 67% | 51–510 | $126 – $21.2k |
| 20 | Piedmont Atlanta Atlanta, GA percent of total billed charges · bothfrom % of charges | 2 | $5.4k | $6.9k | $4.6k | 67% | 51–510 | $126 – $21.2k |
| 21 | Piedmont Fayette Fayetteville, GA percent of total billed charges · bothfrom % of charges | 2 | $5.4k | $6.9k | $4.6k | 67% | 51–510 | $126 – $21.2k |
| 22 | Piedmont Henry Stockbridge, GA percent of total billed charges · bothfrom % of charges | 2 | $5.4k | $6.9k | $4.6k | 67% | 51–510 | $126 – $21.2k |
| 23 | Mayo Clinic Florida Jacksonville, FL facility · percent of total billed charges · bothfrom % of charges | 6 | $1.6k | $3.0k | $5.3k | 177% | 38 | $34 – $39k |
| 24 | Self Regional Healthcare Greenwood, SC facility · other · outpatient | 1 | $4.4k | $4.4k | — | — | 38 | $4.4k – $4.4k |
| 25 | Public Hospital District No 1 of Mason County Shelton, WA fee schedule · both | 2 | $772 | $794 | $364 | 46% | 36–360 | $418 – $1.2k |
← Payers reporting HCPCS C1778 · Snapshot 20261111T120946Z-9134e7f7