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
PR COMPLETED EPSDT
Low
$4
Average
$57
Median
$16
High
$290
Each hospital's average Cigna rate, under the methodology and billing class chosen below.
34 hospitals; the 90th percentile is 29.4× 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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50 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 | Massachusetts General Hospital Boston, MA percent of total billed charges · bothfrom % of charges | 2 | $18 | $18 | $4 | 20% | 60 | $14 – $21 |
| 2 | Brigham and Women's Hospital Boston, MA percent of total billed charges · bothfrom % of charges | 2 | $18 | $18 | $4 | 20% | 15–24 | $14 – $21 |
| 3 | Alomere Health Alexandria, MN facility · fee schedule · outpatient | 1 | $290 | $290 | — | — | — | $290 – $290 |
| 4 | Blue Hill Memorial Hospital Hill, ME facility · fee schedule · outpatient | 1 | $5 | $5 | — | — | — | $5 – $5 |
| 5 | Blue Hill Memorial Hospital Hill, ME professional · fee schedule · outpatient | 1 | $4 | $4 | — | — | — | $4 – $4 |
| 6 | Charles A. Dean Memorial Hospital Greenville, ME facility · fee schedule · outpatient | 1 | $5 | $5 | — | — | — | $5 – $5 |
| 7 | Charles A. Dean Memorial Hospital Greenville, ME professional · fee schedule · outpatient | 1 | $4 | $4 | — | — | — | $4 – $4 |
| 8 | Cheshire Medical Center Keene, NH professional · fee schedule · outpatient | 2 | $5 | $5 | — | — | — | $5 – $5 |
| 9 | Cleveland Clinic Weston Hospital Nonprofit Corporation Weston, FL facility · fee schedule · outpatient | 3 | $6 | $6 | $0 | 4% | — | $6 – $7 |
| 10 | Eastern Maine Medical Center Bangor, ME facility · fee schedule · outpatient | 1 | $5 | $5 | — | — | — | $5 – $5 |
| 11 | Eastern Maine Medical Center Bangor, ME professional · fee schedule · outpatient | 1 | $4 | $4 | — | — | — | $4 – $4 |
| 12 | Fairview Health Services Minneapolis, MN percent of total billed charges · bothfrom % of charges | 1 | $59 | $59 | — | — | — | $59 – $59 |
| 13 | Fairview Maple Grove Surgery Center Maple Grove, MN fee schedule · both | 1 | $109 | $109 | $10 | 9% | — | $100 – $119 |
| 14 | HENRY HEYWOOD MEMORIAL HOSPITAL Gardner, MA fee schedule · outpatient | 1 | $8 | $8 | — | — | — | $8 – $8 |
| 15 | INDIAN RIVER MEMORIAL HOSPITAL INC Vero Beach, FL facility · fee schedule · outpatient | 3 | $9 | $9 | $1 | 10% | — | $8 – $10 |
| 16 | MARTIN MEMORIAL MEDICAL CENTER INC Port St Lucie, FL facility · fee schedule · outpatient | 3 | $8 | $8 | $2 | 23% | — | $6 – $11 |
| 17 | Maine Coast Regional Health Facilities Ellsworth, ME facility · fee schedule · outpatient | 1 | $5 | $5 | — | — | — | $5 – $5 |
| 18 | Maine Coast Regional Health Facilities Ellsworth, ME professional · fee schedule · outpatient | 1 | $4 | $4 | — | — | — | $4 – $4 |
| 19 | Mary Hitchcock Memorial Hospital Lebanon, NH professional · fee schedule · outpatient | 2 | $7 | $7 | — | — | — | $7 – $7 |
| 20 | Mayo Clinic Rochester, MN professional · percent of total billed charges · outpatientfrom % of charges | 4 | $73 | $74 | $2 | 2% | — | $73 – $77 |
| 21 | Mayo Clinic Health System Mankato 56001-4752 facility · percent of total billed charges · bothfrom % of charges | 1 | $124 | $124 | — | — | — | $124 – $124 |
| 22 | Mayo Clinic Health System Mankato 56001-4752 professional · percent of total billed charges · outpatientfrom % of charges | 1 | $124 | $124 | — | — | — | $124 – $124 |
| 23 | Mayo Clinic Health System Lake City 55041-1143 facility · percent of total billed charges · bothfrom % of charges | 1 | $124 | $124 | — | — | — | $124 – $124 |
| 24 | Mayo Clinic Health System Lake City 55041-1143 professional · percent of total billed charges · outpatientfrom % of charges | 1 | $124 | $124 | — | — | — | $124 – $124 |
| 25 | Mayo Clinic Health System Saint James 56081-5550 facility · percent of total billed charges · bothfrom % of charges | 1 | $124 | $124 | — | — | — | $124 – $124 |
← Payers reporting HCPCS S0302 · Snapshot 20261111T120946Z-9134e7f7