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
Procenta, per 100 mg
Low
$48
Average
$2.1k
Median
$1.4k
High
$7.7k
Each hospital's average Anthem rate, under the methodology and billing class chosen below.
33 hospitals; the 90th percentile is 13.8× 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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36 hospital rates
iThe hospitals that file a Anthem 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 | Acadia Hospital Bangor, ME facility · fee schedule · outpatient | 2 | $2.4k | $2.4k | $294 | 12% | — | $2.1k – $2.7k |
| 2 | Acadia Hospital Bangor, ME professional · fee schedule · outpatient | 2 | $1.4k | $1.6k | $360 | 22% | — | $1.4k – $2.2k |
| 3 | Blue Hill Memorial Hospital Hill, ME professional · fee schedule · outpatient | 3 | $1.4k | $1.4k | — | — | — | $1.4k – $1.4k |
| 4 | Boulder Community Health Lafayette, CO professional · fee schedule · both | 2 | $3.4k | $3.4k | — | — | — | $3.4k – $3.4k |
| 5 | Charles A. Dean Memorial Hospital Greenville, ME professional · fee schedule · outpatient | 3 | $1.4k | $1.4k | $35 | 3% | — | $1.3k – $1.4k |
| 6 | Cheshire Medical Center Keene, NH facility · fee schedule · outpatient | 3 | $2.0k | $2.0k | — | — | — | $2.0k – $2.0k |
| 7 | Cheshire Medical Center Keene, NH professional · fee schedule · outpatient | 1 | $5.0k | $5.0k | — | — | — | $5.0k – $5.0k |
| 8 | Community Memorial Hospital of Menomonee Falls Inc Menomonee Falls, WI fee schedule · outpatient | 2 | $4.2k | $4.2k | $2.4k | 57% | — | $1.8k – $6.6k |
| 9 | Curators of the University of Missouri Jefferson City, MO facility · fee schedule · outpatient | 3 | $5.9k | $5.9k | — | — | — | $5.9k – $5.9k |
| 10 | Deaconess Hospital, Inc Newburgh, IN facility · case rate · outpatient | 1 | $49 | $49 | — | — | — | $49 – $49 |
| 11 | Eastern Maine Medical Center Bangor, ME professional · fee schedule · outpatient | 3 | $1.4k | $1.4k | — | — | — | $1.4k – $1.4k |
| 12 | Froedtert Bluemound Rehabilitation Hospital Wauwatosa, WI fee schedule · outpatient | 2 | $7.7k | $7.7k | $1.2k | 15% | — | $6.6k – $8.9k |
| 13 | Froedtert Memorial Lutheran Hospital Inc Milwaukee, WI fee schedule · outpatient | 2 | $7.7k | $7.7k | $1.2k | 15% | — | $6.6k – $8.9k |
| 14 | Grady Memorial Hospital Atlanta, GA professional · fee schedule · outpatient | 1 | $1.4k | $1.4k | — | — | — | $1.4k – $1.4k |
| 15 | Holy Family Memorial Inc Manitowoc, WI fee schedule · outpatient | 1 | $1.8k | $1.8k | — | — | — | $1.8k – $1.8k |
| 16 | Little Company of Mary Hospital of Indiana Inc Jasper, IN facility · fee schedule · outpatient | 1 | $48 | $48 | — | — | — | $48 – $48 |
| 17 | Maine Coast Regional Health Facilities Ellsworth, ME professional · fee schedule · outpatient | 3 | $1.4k | $1.4k | — | — | — | $1.4k – $1.4k |
| 18 | Mary Hitchcock Memorial Hospital Lebanon, NH facility · fee schedule · outpatient | 5 | $5.0k | $4.3k | $1.0k | 24% | — | $2.4k – $5.0k |
| 19 | Mary Hitchcock Memorial Hospital Lebanon, NH professional · fee schedule · outpatient | 6 | $2.2k | $2.1k | $306 | 15% | — | $1.4k – $2.2k |
| 20 | Mayo Regional Hospital Dover Foxcroft, ME professional · fee schedule · outpatient | 2 | $1.8k | $1.8k | $382 | 22% | — | $1.4k – $2.2k |
| 21 | Mercy Hospital Portland, ME professional · fee schedule · outpatient | 3 | $1.4k | $1.4k | — | — | — | $1.4k – $1.4k |
| 22 | Meriter Hospital, Inc Madison, WI fee schedule · both | 3 | $1.3k | $1.3k | — | — | — | $1.3k – $1.3k |
| 23 | Norton Healthcare Indiana Inc Jeffersonville, IN fee schedule · outpatient | 1 | $48 | $48 | — | — | — | $48 – $48 |
| 24 | Sebasticook Valley Health Pittsfield, ME professional · fee schedule · outpatient | 3 | $1.4k | $1.4k | $35 | 3% | — | $1.3k – $1.4k |
| 25 | St Josephs Community Hospital of West Bend Inc West Bend, WI fee schedule · outpatient | 2 | $4.2k | $4.2k | $2.4k | 57% | — | $1.8k – $6.6k |
← Payers reporting HCPCS Q4310 · Snapshot 20261112T181611Z-3fa9fb76