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
Replc tth&acrlc on mtl frmwk
Low
$207
Average
$582
Median
$352
High
$1.1k
Each hospital's average Cigna rate, under the methodology and billing class chosen below.
21 hospitals; the 90th percentile is 2.9× 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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21 hospital rates
iThe hospitals that file a Cigna 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 | ADVENTIST HEALTH MEDICAL CENTER TEHACHAPI Tehachapi, CA percent of total billed charges · outpatientfrom % of charges | 1 | $890 | $890 | — | — | — | $890 – $890 |
| 2 | ADVENTIST HEALTH MENDOCINO COAST Bragg, CA percent of total billed charges · outpatientfrom % of charges | 1 | $889 | $889 | — | — | — | $889 – $889 |
| 3 | Alomere Health Alexandria, MN facility · fee schedule · outpatient | 1 | $706 | $706 | — | — | — | $706 – $706 |
| 4 | Blue Hill Memorial Hospital Hill, ME professional · fee schedule · outpatient | 1 | $352 | $352 | — | — | — | $352 – $352 |
| 5 | Chambers Health Anahuac, TX percent of total billed charges · outpatientfrom % of charges | 1 | $415 | $415 | — | — | — | $415 – $415 |
| 6 | Charles A. Dean Memorial Hospital Greenville, ME professional · fee schedule · outpatient | 1 | $352 | $352 | — | — | — | $352 – $352 |
| 7 | Cheshire Medical Center Keene, NH professional · fee schedule · outpatient | 2 | $330 | $330 | — | — | — | $330 – $330 |
| 8 | Eastern Maine Medical Center Bangor, ME professional · fee schedule · outpatient | 1 | $352 | $352 | — | — | — | $352 – $352 |
| 9 | LODI MEMORIAL HOSPITAL ASSOCIATION INC Lodi, CA percent of total billed charges · outpatientfrom % of charges | 1 | $1.0k | $1.0k | — | — | — | $1.0k – $1.0k |
| 10 | MVHS, Inc. Utica, NY percent of total billed charges · bothfrom % of charges | 1 | $207 | $207 | — | — | — | $207 – $207 |
| 11 | Maine Coast Regional Health Facilities Ellsworth, ME professional · fee schedule · outpatient | 1 | $352 | $352 | — | — | — | $352 – $352 |
| 12 | Mary Hitchcock Memorial Hospital Lebanon, NH professional · fee schedule · outpatient | 2 | $286 | $286 | — | — | — | $286 – $286 |
| 13 | Mayo Regional Hospital Dover Foxcroft, ME professional · fee schedule · outpatient | 1 | $352 | $352 | — | — | — | $352 – $352 |
| 14 | Mercy Hospital Portland, ME professional · fee schedule · outpatient | 1 | $352 | $352 | — | — | — | $352 – $352 |
| 15 | REEDLEY COMMUNITY HOSPITAL Reedley, CA percent of total billed charges · outpatientfrom % of charges | 1 | $741 | $741 | — | — | — | $741 – $741 |
| 16 | SONORA COMMUNITY HOSPITAL Sonora, CA percent of total billed charges · outpatientfrom % of charges | 1 | $1.1k | $1.1k | — | — | — | $1.1k – $1.1k |
| 17 | Sebasticook Valley Health Pittsfield, ME professional · fee schedule · outpatient | 1 | $352 | $352 | — | — | — | $352 – $352 |
| 18 | The Aroostook Medical Center Isle, ME professional · fee schedule · outpatient | 1 | $352 | $352 | — | — | — | $352 – $352 |
| 19 | The Cleveland Clinic Foundation Brunswick, OH professional · percent of total billed charges · outpatientfrom % of charges | 1 | $960 | $960 | — | — | — | $960 – $960 |
| 20 | UKIAH ADVENTIST HOSPITAL Ukiah, CA percent of total billed charges · outpatientfrom % of charges | 1 | $889 | $889 | — | — | — | $889 – $889 |
| 21 | WILLITS HOSPITAL INC Willits, CA percent of total billed charges · outpatientfrom % of charges | 1 | $969 | $969 | — | — | — | $969 – $969 |
← Payers reporting HCPCS D5670 · Snapshot 20261112T124536Z-e251e855