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
$1.3k
Average
$12.0k
Median
$9.2k
High
$36.8k
Each hospital's average Tricare rate, under the methodology and billing class chosen below.
55 hospitals; the 90th percentile is 11.7× 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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62 hospital rates
iThe hospitals that file a Tricare 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 | Armstrong County Memorial Hospital Kittanning, PA facility · fee schedule · outpatient | 1 | $7.0k | $9.6k | $5.4k | 57% | — | $5.4k – $18.7k |
| 2 | Baptist Medical Center-Attala Kosciusko, MS facility · percent of total billed charges · outpatientfrom % of charges | 1 | — | — | — | — | — | — – — |
| 3 | Baptist Medical Center-Yazoo Yazoo City, MS facility · percent of total billed charges · outpatientfrom % of charges | 1 | — | — | — | — | — | — – — |
| 4 | Baptist Memorial Hospital - Leake Carthage, MS facility · percent of total billed charges · outpatientfrom % of charges | 1 | — | — | — | — | — | — – — |
| 5 | Beaufort Memorial Hospital Beaufort, SC facility · percent of total billed charges · inpatientfrom % of charges | 1 | $2.2k | $2.2k | $403 | 18% | — | $1.8k – $2.6k |
| 6 | CORNING HOSPITAL Corning, NY facility · other · outpatient | 1 | $10.3k | $10.3k | — | — | — | $10.3k – $10.3k |
| 7 | CentraState Medical Center Freehold Township, NJ other · outpatient | 2 | $33.7k | $33.7k | — | — | — | $33.7k – $33.7k |
| 8 | Charleston Area Medical Center Charleston, WV percent of total billed charges · bothfrom % of charges | 1 | $12.4k | $13.8k | $8.4k | 60% | — | $1.6k – $35.2k |
| 9 | Chilton Medical Center Pompton Plains, NJ other · outpatient | 2 | $24.9k | $24.9k | — | — | — | $24.9k – $24.9k |
| 10 | Conway Regional Medical Center Conway, AR facility · fee schedule · outpatient | 1 | $3.0k | $5.5k | $5.0k | 91% | — | $129 – $14.2k |
| 11 | Doylestown Hospital Doylestown, PA facility · fee schedule · outpatient | 1 | $14.2k | $14.7k | $3.9k | 27% | — | $10.2k – $22.2k |
| 12 | Dukes Health System LLC Peru, IN facility · fee schedule · outpatient | 1 | $4.2k | $4.2k | — | — | — | $4.2k – $4.2k |
| 13 | Ellis Hospital NY 12308; 2210 Troy Schenectady Road Niskayuna, NY facility · fee schedule · outpatient | 1 | $17.8k | $17.5k | $11.5k | 66% | — | $405 – $35.2k |
| 14 | GUTHRIE CORTLAND MEDICAL CENTER Cortland, NY facility · other · outpatient | 1 | $13.5k | $13.5k | $3.2k | 23% | — | $10.3k – $16.6k |
| 15 | Garfield County, a political subdivision of the State of Utah, DBA Intermountain Health Garfield Memorial Hospital Panguitch, UT facility · percent of total billed charges · inpatientfrom % of charges | 1 | $3.3k | $2.9k | $961 | 34% | — | $1.5k – $3.7k |
| 16 | Garfield County, a political subdivision of the State of Utah, DBA Intermountain Health Garfield Memorial Hospital Panguitch, UT facility · percent of total billed charges · outpatientfrom % of charges | 1 | $2.8k | $2.4k | $808 | 34% | — | $1.3k – $3.1k |
| 17 | Hackettstown Medical Center Hackettstown, NJ other · outpatient | 2 | $33.3k | $33.3k | — | — | — | $33.3k – $33.3k |
| 18 | Hemet Global Medical Center Hemet, CA facility · fee schedule · outpatient | 1 | $44.6k | $44.6k | — | — | — | $44.6k – $44.6k |
| 19 | Hemet Global Medical Center Hemet, CA professional · fee schedule · outpatient | 1 | $29.0k | $29.0k | — | — | — | $29.0k – $29.0k |
| 20 | Holy Cross Germantown Hospital Germantown, MD facility · percent of total billed charges · bothfrom % of charges | 1 | $4.2k | $5.5k | $4.7k | 86% | — | $137 – $21.2k |
| 21 | Holy Cross Hospital-Silver Spring Silver Spring, MD facility · percent of total billed charges · bothfrom % of charges | 1 | $4.4k | $5.8k | $6.7k | 115% | — | $51 – $49.1k |
| 22 | Hospital Authority of Colquitt County Moultrie, GA fee schedule · both | 1 | $5.4k | $5.3k | $3.8k | 72% | — | $157 – $12.6k |
| 23 | KAPLAN GENERAL HOSPITAL, INC ST, LA percent of total billed charges · outpatientfrom % of charges | 1 | $5.0k | $6.8k | $8.9k | 131% | — | $204 – $60.4k |
| 24 | Kaweah Health Medical Center Visalia, CA facility · fee schedule · outpatient | 1 | $5.1k | $7.0k | $5.4k | 76% | — | $126 – $15.6k |
| 25 | Kaweah Health Mental Health Hospital Visalia, CA facility · fee schedule · outpatient | 1 | $5.1k | $7.0k | $5.4k | 76% | — | $126 – $15.6k |
← Payers reporting HCPCS C1778 · Snapshot 20261111T120946Z-9134e7f7