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
Fee Schedule
Low
$2
Average
$66
Median
$5
High
$2.1k
Each hospital's average Cigna rate, under the methodology and billing class chosen below.
46 hospitals; the 90th percentile is 44.7× 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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54 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 | Alomere Health Alexandria, MN facility · fee schedule · outpatient | 1 | $27 | $27 | — | — | — | $27 – $27 |
| 2 | Beaufort Memorial Hospital Beaufort, SC facility · percent of total billed charges · inpatientfrom % of charges | 1 | $120 | $120 | $2 | 2% | — | $118 – $122 |
| 3 | Beaufort Memorial Hospital Beaufort, SC facility · percent of total billed charges · outpatientfrom % of charges | 1 | $120 | $120 | $2 | 2% | — | $118 – $122 |
| 4 | Central Georgia Rehabilitation LLC Macon, GA fee schedule · both | 1 | $2 | $2 | — | — | — | $2 – $2 |
| 5 | Cheshire Medical Center Keene, NH professional · fee schedule · outpatient | 2 | $2 | $2 | — | — | — | $2 – $2 |
| 6 | Fairview Maple Grove Surgery Center Maple Grove, MN fee schedule · both | 1 | $10 | $10 | $1 | 9% | — | $9 – $11 |
| 7 | HMH HOSPITALS CORPORATION Edison, NJ facility · fee schedule · outpatient | 2 | $3 | $3 | — | — | — | $3 – $3 |
| 8 | HMH HOSPITALS CORPORATION Brick, NJ facility · fee schedule · outpatient | 2 | $3 | $3 | — | — | — | $3 – $3 |
| 9 | HMH HOSPITALS CORPORATION Edison, NJ facility · fee schedule · outpatient | 2 | $3 | $3 | — | — | — | $3 – $3 |
| 10 | HOLY ROSARY HEALTHCARE DBA INTERMOUNTAIN HEALTH HOLY ROSARY HOSPITAL CITY, MT professional · fee schedule · outpatient | 4 | $12 | $12 | — | — | — | $12 – $12 |
| 11 | Henry Ford Health System West Bloomfield, MI facility · percent of total billed charges · outpatientfrom % of charges | 1 | $8 | $8 | $6 | 69% | — | $3 – $14 |
| 12 | Henry Ford Health System Plymouth, MI facility · percent of total billed charges · outpatientfrom % of charges | 2 | $8 | $9 | $6 | 69% | — | $3 – $15 |
| 13 | Kalkaska Memorial Health Center Kalkaska, MI facility · percent of total billed charges · inpatientfrom % of charges | 1 | $72 | $72 | — | — | — | $72 – $72 |
| 14 | Kalkaska Memorial Health Center Kalkaska, MI facility · percent of total billed charges · outpatientfrom % of charges | 1 | $72 | $72 | — | — | — | $72 – $72 |
| 15 | MEDICAL CITY ARLINGTON GRAND PRAIRIE, TX percent of total billed charges · outpatientfrom % of charges | 8 | $9 | $8 | $2 | 30% | — | $4 – $12 |
| 16 | MEDICAL CITY FORT WORTH FORT WORTH, TX percent of total billed charges · outpatientfrom % of charges | 9 | $113 | $110 | $43 | 39% | — | $52 – $202 |
| 17 | MEDICAL CITY LAS COLINAS Irving, TX percent of total billed charges · outpatientfrom % of charges | 8 | $2 | $2 | $1 | 29% | — | $1 – $3 |
| 18 | Mary Hitchcock Memorial Hospital Lebanon, NH facility · fee schedule · outpatient | 1 | $8 | $8 | — | — | — | $8 – $8 |
| 19 | Mary Hitchcock Memorial Hospital Lebanon, NH professional · fee schedule · outpatient | 2 | $2 | $2 | — | — | — | $2 – $2 |
| 20 | Memorial Healthcare Owosso, MI fee schedule · outpatient | 1 | $2 | $2 | — | — | — | $2 – $2 |
| 21 | Memorial Hospital of Laramie County Cheyenne, WY fee schedule · both | 1 | $2 | $2 | — | — | — | $2 – $2 |
| 22 | Mid Hudson Regional Hospital Poughkeepsie, NY facility · percent of total billed charges · inpatientfrom % of charges | 1 | $2 | $2 | — | — | — | $2 – $2 |
| 23 | Mid Hudson Regional Hospital Poughkeepsie, NY facility · percent of total billed charges · outpatientfrom % of charges | 1 | $2 | $2 | — | — | — | $2 – $2 |
| 24 | Montefiore Medical Center Bronx, NY fee schedule · both | 2 | $2 | $2 | — | — | — | $2 – $2 |
| 25 | Munson Healthcare Cadillac Cadillac, MI facility · percent of total billed charges · outpatientfrom % of charges | 1 | $2.1k | $2.1k | $2.1k | 98% | — | $42 – $4.2k |
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