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
CAST SUPPLIES UNLISTED
Low
$0
Average
$87
Median
$52
High
$375
Each hospital's average Blue Cross Blue Shield rate, under the methodology and billing class chosen below.
75 hospitals; the 90th percentile is 9.3× 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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91 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 | Northern Hospital District of Surry County Mount Airy, NC facility · fee schedule · both | 1 | $15 | $15 | — | — | 7–70 | $15 – $15 |
| 2 | West Virginia University Hospitals, Inc. Morgantown, WV facility · percent of total billed charges · outpatientfrom % of charges | 1 | $82 | $82 | — | — | 3–30 | $82 – $82 |
| 3 | Wetzel County Hospital, Inc. New Martinsville, WV facility · percent of total billed charges · outpatientfrom % of charges | 1 | $198 | $198 | — | — | 1–10 | $198 – $198 |
| 4 | ALICE_PECK_DAY_MEMORIAL_HOSPITAL LEBANON, NH percent of total billed charges · outpatientfrom % of charges | 7 | $96 | $91 | $21 | 23% | — | $45 – $121 |
| 5 | Alomere Health Alexandria, MN facility · fee schedule · outpatient | 2 | $22 | $22 | — | — | — | $22 – $22 |
| 6 | Altru Hospital Grand Forks, ND facility · fee schedule · outpatient | 2 | $22 | $22 | — | — | — | $22 – $22 |
| 7 | Altru Hospital Devils Lake Devils Lake, ND facility · fee schedule · outpatient | 2 | $22 | $22 | — | — | — | $22 – $22 |
| 8 | Amisub of South Carolina, Inc. Fort Mill, SC fee schedule · outpatient | 4 | $1 | $1 | $0 | 43% | — | $0 – $1 |
| 9 | Benefis Hospitals Inc Helena, MT percent of total billed charges · bothfrom % of charges | 4 | $192 | $285 | $204 | 71% | — | $105 – $783 |
| 10 | Benefis Hospitals Inc Helena, MT percent of total billed charges · inpatientfrom % of charges | 2 | $194 | $275 | $196 | 71% | — | $112 – $741 |
| 11 | Benefis Hospitals Inc Helena, MT percent of total billed charges · outpatientfrom % of charges | 2 | $160 | $228 | $163 | 71% | — | $91 – $625 |
| 12 | Benson Hospital Corporation Benson, AZ facility · fee schedule · outpatient | 1 | $306 | $306 | — | — | — | $306 – $306 |
| 13 | Boston Children's Hospital Boston, MA percent of total billed charges · bothfrom % of charges | 1 | $198 | $198 | — | — | — | $198 – $198 |
| 14 | Boston Children's Hospital Lexington, MA percent of total billed charges · bothfrom % of charges | 1 | $198 | $198 | — | — | — | $198 – $198 |
| 15 | Boston Children's Hospital Brookline, MA percent of total billed charges · bothfrom % of charges | 1 | $198 | $198 | — | — | — | $198 – $198 |
| 16 | Boston Children's Hospital Dartmouth, MA percent of total billed charges · bothfrom % of charges | 1 | $198 | $198 | — | — | — | $198 – $198 |
| 17 | Boston Children's Hospital Boston, MA percent of total billed charges · bothfrom % of charges | 4 | $183 | $183 | $11 | 6% | — | $169 – $198 |
| 18 | Boston Children's Hospital Peabody, MA percent of total billed charges · bothfrom % of charges | 1 | $198 | $198 | — | — | — | $198 – $198 |
| 19 | Boston Children's Hospital Waltham, MA percent of total billed charges · bothfrom % of charges | 2 | $184 | $184 | $14 | 8% | — | $169 – $198 |
| 20 | Boston Children's Hospital Needham, MA percent of total billed charges · bothfrom % of charges | 1 | $198 | $198 | — | — | — | $198 – $198 |
| 21 | Boston Children's Hospital Weymouth, MA percent of total billed charges · bothfrom % of charges | 1 | $198 | $198 | — | — | — | $198 – $198 |
| 22 | COLUMBIA MEMORIAL HOSPITAL Hudson, NY professional · fee schedule · outpatient | 8 | $60 | $60 | $2 | 4% | — | $56 – $62 |
| 23 | Children's Healthcare of Atlanta Atlanta, GA percent of total billed charges · outpatientfrom % of charges | 3 | $317 | $375 | $83 | 22% | — | $317 – $492 |
| 24 | Conway Hospital, Inc. Conway, SC facility · percent of total billed charges · inpatientfrom % of charges | 4 | $14 | $17 | $9 | 54% | — | $7 – $36 |
| 25 | Conway Hospital, Inc. Conway, SC facility · percent of total billed charges · outpatientfrom % of charges | 3 | $13 | $13 | $6 | 45% | — | $7 – $25 |
← Payers reporting HCPCS Q4050 · Snapshot 20261111T120946Z-9134e7f7