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
$1
Average
$14
Median
$3
High
$108
Each hospital's average Cigna rate, under the methodology and billing class chosen below.
76 hospitals; the 90th percentile is 44.2× 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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86 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 | Adena Health System Chillicothe, OH facility · fee schedule · outpatient | 1 | $2 | $2 | — | — | — | $2 – $2 |
| 2 | Alomere Health Alexandria, MN facility · fee schedule · outpatient | 1 | $3 | $3 | — | — | — | $3 – $3 |
| 3 | COQUILLE VALLEY HOSPITAL COQUILLE, OR percent of total billed charges · bothfrom % of charges | 1 | $12 | $12 | — | — | — | $12 – $12 |
| 4 | Central Georgia Rehabilitation LLC Macon, GA fee schedule · both | 1 | $1 | $1 | — | — | — | $1 – $1 |
| 5 | Cheshire Medical Center Keene, NH professional · fee schedule · outpatient | 2 | $1 | $1 | — | — | — | $1 – $1 |
| 6 | Fairview Maple Grove Surgery Center Maple Grove, MN fee schedule · both | 1 | $1 | $1 | $0 | 9% | — | $1 – $1 |
| 7 | HCA HOUSTON HEALTHCARE CLEAR LAKE WEBSTER, TX percent of total billed charges · outpatientfrom % of charges | 3 | $5 | $5 | $1 | 11% | — | $5 – $6 |
| 8 | HCA HOUSTON HEALTHCARE MEDICAL CENTER HOUSTON, TX percent of total billed charges · outpatientfrom % of charges | 3 | $12 | $14 | $11 | 74% | — | $2 – $35 |
| 9 | HCA HOUSTON HEALTHCARE NORTHWEST HOUSTON, TX percent of total billed charges · outpatientfrom % of charges | 3 | $10 | $14 | $11 | 79% | — | $2 – $32 |
| 10 | HCA HOUSTON HEALTHCARE PEARLAND HOUSTON, TX percent of total billed charges · outpatientfrom % of charges | 3 | $3 | $3 | $0 | 11% | — | $3 – $3 |
| 11 | HCA HOUSTON HEALTHCARE SOUTHEAST HOUSTON, TX percent of total billed charges · outpatientfrom % of charges | 4 | $9 | $13 | $14 | 107% | — | $3 – $47 |
| 12 | HCA HOUSTON HEALTHCARE TOMBALL Tomball, TX percent of total billed charges · outpatientfrom % of charges | 3 | $4 | $6 | $4 | 65% | — | $2 – $12 |
| 13 | HCA Houston Rehabilitation Hospital Southeast Pasadena, TX percent of total billed charges · outpatientfrom % of charges | 4 | $9 | $13 | $14 | 107% | — | $3 – $47 |
| 14 | HMH HOSPITALS CORPORATION Edison, NJ facility · fee schedule · outpatient | 2 | $1 | $1 | — | — | — | $1 – $1 |
| 15 | HMH HOSPITALS CORPORATION Brick, NJ facility · fee schedule · outpatient | 2 | $1 | $1 | — | — | — | $1 – $1 |
| 16 | HMH HOSPITALS CORPORATION Edison, NJ facility · fee schedule · outpatient | 2 | $1 | $1 | — | — | — | $1 – $1 |
| 17 | HOLY ROSARY HEALTHCARE DBA INTERMOUNTAIN HEALTH HOLY ROSARY HOSPITAL CITY, MT professional · fee schedule · outpatient | 4 | $2 | $2 | — | — | — | $2 – $2 |
| 18 | Haxtun Hospital District Haxtun, CO fee schedule · outpatient | 1 | $15 | $15 | — | — | — | $15 – $15 |
| 19 | HealthAlliance - Clinton Hospital MA 01453; 201 Highland St Clinton, MA percent of total billed charges · bothfrom % of charges | 1 | $9 | $9 | $0 | 4% | — | $9 – $10 |
| 20 | Hospital Authority of Colquitt County Moultrie, GA fee schedule · both | 1 | $35 | $35 | $1 | 2% | — | $34 – $35 |
| 21 | Kalkaska Memorial Health Center Kalkaska, MI facility · percent of total billed charges · inpatientfrom % of charges | 1 | $6 | $6 | — | — | — | $6 – $6 |
| 22 | Kalkaska Memorial Health Center Kalkaska, MI facility · percent of total billed charges · outpatientfrom % of charges | 1 | $6 | $6 | — | — | — | $6 – $6 |
| 23 | Kemper CAH, Inc. DeKalb, MS other · outpatient | 1 | $3 | $3 | — | — | — | $3 – $3 |
| 24 | Laird Hospital, Inc. Union, MS other · outpatient | 1 | $3 | $3 | $0 | 6% | — | $3 – $3 |
| 25 | METHODIST HOSPITAL HELOTES, TX percent of total billed charges · outpatientfrom % of charges | 5 | $79 | $80 | $9 | 11% | — | $72 – $96 |
← Payers reporting HCPCS S0171 · Snapshot 20261112T181611Z-3fa9fb76