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
AmnioExcel 4cm x 8cm disk
Low
$91
Average
$758
Median
$127
High
$10.9k
Each hospital's average Tricare rate, under the methodology and billing class chosen below.
64 hospitals; the 90th percentile is 28.3× 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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66 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 | Affinity Hospital LLC Birmingham, AL facility · fee schedule · outpatient | 1 | $127 | $127 | — | — | — | $127 – $127 |
| 2 | Armstrong County Memorial Hospital Kittanning, PA facility · fee schedule · outpatient | 1 | $127 | $127 | — | — | — | $127 – $127 |
| 3 | CLAIBORNE MEDICAL CENTER Tazewell, TN fee schedule · outpatient | 1 | $121 | $121 | — | — | — | $121 – $121 |
| 4 | CUMBERLAND MEDICAL CENTER, INC. Crossville, TN fee schedule · outpatient | 1 | $121 | $121 | — | — | — | $121 – $121 |
| 5 | Canton-Potsdam Hospital Potsdam, NY facility · fee schedule · outpatient | 1 | $109 | $109 | — | — | — | $109 – $109 |
| 6 | Central Maine Medical Center Lewiston, ME fee schedule · outpatient | 1 | $127 | $127 | — | — | — | $127 – $127 |
| 7 | Charleston Area Medical Center Charleston, WV percent of total billed charges · bothfrom % of charges | 1 | $8.8k | $10.9k | $7.2k | 66% | — | $2.7k – $21.3k |
| 8 | Columbia Lutheran Charities Astoria, OR facility · percent of total billed charges · bothfrom % of charges | 1 | $1.0k | $1.2k | $1.2k | 102% | — | $442 – $5.9k |
| 9 | Conway Regional Medical Center Conway, AR facility · fee schedule · outpatient | 1 | $704 | $792 | $372 | 47% | — | $441 – $1.3k |
| 10 | Crestview Hospital Corporation Crestview, FL facility · fee schedule · outpatient | 1 | $127 | $127 | — | — | — | $127 – $127 |
| 11 | Doylestown Hospital Doylestown, PA facility · fee schedule · outpatient | 1 | $127 | $127 | — | — | — | $127 – $127 |
| 12 | East Georgia Regional Medical Center LLC Statesboro, GA facility · fee schedule · outpatient | 1 | $127 | $127 | — | — | — | $127 – $127 |
| 13 | Ellis Hospital NY 12308; 2210 Troy Schenectady Road Niskayuna, NY facility · fee schedule · outpatient | 1 | $127 | $127 | — | — | — | $127 – $127 |
| 14 | FORT LOUDOUN MEDICAL CENTER Lenoir City, TN fee schedule · outpatient | 1 | $113 | $113 | — | — | — | $113 – $113 |
| 15 | FORT SANDERS REGIONAL MEDICAL CENTER Knoxville, TN fee schedule · both | 1 | $113 | $113 | — | — | — | $113 – $113 |
| 16 | GRITMAN MEDICAL CENTER INC Moscow, ID facility · fee schedule · both | 1 | $150 | $150 | — | — | — | $150 – $150 |
| 17 | Gadsden Regional Medical Center LLC Gadsden, AL facility · fee schedule · outpatient | 1 | $127 | $127 | — | — | — | $127 – $127 |
| 18 | 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 | $44 | $99 | $94 | 95% | — | $44 – $262 |
| 19 | 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 | $37 | $83 | $79 | 95% | — | $37 – $220 |
| 20 | HSA PGH LLC Hialeah, FL facility · percent of total billed charges · outpatientfrom % of charges | 1 | $127 | $127 | — | — | — | $127 – $127 |
| 21 | Hemet Global Medical Center Hemet, CA facility · fee schedule · outpatient | 1 | $127 | $127 | — | — | — | $127 – $127 |
| 22 | Hemet Global Medical Center Hemet, CA professional · fee schedule · outpatient | 1 | $117 | $117 | $1 | 1% | — | $116 – $119 |
| 23 | Kaleida Health Buffalo, NY fee schedule · outpatient | 1 | $148 | $148 | — | — | — | $148 – $148 |
| 24 | LECONTE MEDICAL CENTER Sevierville, TN fee schedule · outpatient | 1 | $121 | $121 | — | — | — | $121 – $121 |
| 25 | Las Cruces Medical Center LLC Las Cruces, NM facility · fee schedule · outpatient | 1 | $127 | $127 | — | — | — | $127 – $127 |
← Payers reporting HCPCS Q4137 · Snapshot 20261111T120946Z-9134e7f7