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
$7.5k
Median
$5.9k
High
$377.8k
Each hospital's average UnitedHealthcare rate, under the methodology and billing class chosen below.
1239 hospitals; the 90th percentile is 6.9× 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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1,700 hospital rates
iThe hospitals that file a UnitedHealthcare 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 Arizona Phoenix, AZ facility · percent of total billed charges · bothfrom % of charges | 2 | $1.7k | $3.1k | $5.7k | 182% | 424–4,240 | $41 – $40.6k |
| 2 | Holy Cross Hospital-Silver Spring Silver Spring, MD facility · percent of total billed charges · bothfrom % of charges | 3 | $4.2k | $5.5k | $6.3k | 115% | 201–2,010 | $47 – $48.6k |
| 3 | Mayo Clinic Florida Jacksonville, FL facility · percent of total billed charges · bothfrom % of charges | 2 | $1.4k | $2.7k | $4.7k | 177% | 195–1,950 | $33 – $33.3k |
| 4 | Mayo Clinic Health System Eau Claire 54703-5270 facility · percent of total billed charges · bothfrom % of charges | 1 | $2.2k | $4.2k | $8.3k | 197% | 169–1,690 | $55 – $55.2k |
| 5 | St Josephs Hospital Health Center Syracuse, NY facility · percent of total billed charges · bothfrom % of charges | 7 | $4.3k | $5.3k | $4.8k | 90% | 126–1,260 | $64 – $25.0k |
| 6 | The Charlotte Mecklenburg Hospital Authority Waxhaw, NC other · outpatient | 2 | $4.6k | $4.6k | — | — | 126–1,260 | $4.6k – $4.6k |
| 7 | University of Wisconsin Hospital and Clinics Authority WI 53718; 1675 Highland Ave Madison, WI percent of total billed chargesfrom % of charges | 3 | $4.8k | $4.9k | $2.2k | 46% | 99–990 | $580 – $12.5k |
| 8 | Duke University Hospital Durham, NC facility · percent of total billed charges · outpatientfrom % of charges | 2 | $5.4k | $11.8k | $11.9k | 101% | 97–970 | $2 – $56.9k |
| 9 | Duke University Hospital Raleigh, NC facility · percent of total billed charges · outpatientfrom % of charges | 2 | $5.4k | $11.8k | $11.9k | 101% | 97–970 | $2 – $56.9k |
| 10 | St Luke's Regional Medical Center, LTD Mountain Home, ID percent of total billed charges · bothfrom % of charges | 1 | $4.5k | $5.9k | $6.0k | 102% | 77–770 | $235 – $30.1k |
| 11 | St Joseph Mercy Chelsea Chelsea, MI facility · percent of total billed charges · bothfrom % of charges | 1 | $1.6k | $1.9k | $1.5k | 80% | 72–720 | $3 – $6.9k |
| 12 | Mount Carmel Dublin Dublin, OH facility · percent of total billed charges · bothfrom % of charges | 2 | $4.3k | $5.2k | $4.5k | 85% | 67–670 | $86 – $20.4k |
| 13 | Saint Marys Hospital Waterbury, CT facility · percent of total billed charges · bothfrom % of charges | 1 | $3.1k | $5.1k | $5.5k | 108% | 67–670 | $83 – $29.5k |
| 14 | Mount Carmel St Ann's Lewis Center, OH facility · percent of total billed charges · bothfrom % of charges | 2 | $4.1k | $5.1k | $4.4k | 86% | 66–660 | $81 – $20.4k |
| 15 | Mount Carmel Grove City Grove City, OH facility · percent of total billed charges · bothfrom % of charges | 2 | $4.3k | $5.4k | $4.5k | 83% | 65–650 | $86 – $20.4k |
| 16 | Mercy Health Saint Marys Rockford, MI facility · percent of total billed charges · bothfrom % of charges | 2 | $3.1k | $3.9k | $3.4k | 86% | 62–620 | $5 – $15.7k |
| 17 | St Mary Mercy Livonia Livonia, MI facility · percent of total billed charges · bothfrom % of charges | 1 | $2.5k | $3.3k | $2.8k | 85% | 62–620 | $4 – $12.6k |
| 18 | Mercy Hospital Springfield Ozark, MO facility · percent of total billed charges · outpatientfrom % of charges | 3 | $4.8k | $5.1k | $2.8k | 55% | 61–484 | $1.1k – $12.5k |
| 19 | St Joseph Mercy Oakland Pontiac, MI facility · percent of total billed charges · bothfrom % of charges | 1 | $4.2k | $4.8k | $4.3k | 89% | 61–610 | $3 – $21.5k |
| 20 | Self Regional Healthcare Greenwood, SC facility · percent of total billed charges · outpatientfrom % of charges | 1 | $7.2k | $8.6k | $7.2k | 83% | 58–580 | $213 – $31.9k |
| 21 | Mercy Hospital Springfield Springfield, MO facility · percent of total billed charges · outpatientfrom % of charges | 3 | $5.0k | $5.3k | $2.8k | 53% | 44–314 | $1.1k – $12.5k |
| 22 | Bexar County Hospital District San Antonio, TX percent of total billed charges · outpatientfrom % of charges | 1 | $6.2k | $5.9k | $3.5k | 58% | 43–430 | $2 – $13.5k |
| 23 | Public Hospital Dis No 1 Skagit dba Skagit Valley Hospital Vernon, WA fee schedule · both | 2 | $60.4k | $60.4k | $33.3k | 55% | 42–204 | $27.2k – $93.7k |
| 24 | Mercy Hospital Oklahoma City Inc City, OK facility · percent of total billed charges · outpatientfrom % of charges | 2 | $4.1k | $4.4k | $2.2k | 51% | 35–350 | $813 – $8.6k |
| 25 | St. Lukes Hospital of Kansas City City, KS percent of total billed charges · bothfrom % of charges | 17 | $810 | $826 | $310 | 38% | 34–340 | $279 – $1.8k |
← Payers reporting HCPCS C1778 · Snapshot 20261111T120946Z-9134e7f7