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
M/PHMTRC ALYS ISHQUANT/SEMIQ
Kyle, TX
See all hospitals reporting CPT 88377 →Price type
Ascension Seton’s median price of $395 is 34% above the median hospital's median price ($294), higher than 70% of the 2,288 hospitals reporting CPT 88377. The highlighted bar is where this hospital falls; shaded is the middle 50% of hospitals.
Negotiated rates from the hospital’s own file: 9 payers, 27 plan rates. A facility fee, a professional fee, a per diem and a case rate are different bills, so each is listed on its own. Open a payer to see it across hospitals.
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| # | |||||||
|---|---|---|---|---|---|---|---|
| 1 | Aetna 4659_medicare advantage aetna inpatient 20251001 other · inpatient | $166 | $166 | — | — | — | $166 – $166 |
| 2 | Aetna 4749_medicare advantage aetna outpatient 20250811 other · outpatient | $166 | $166 | — | — | — | $166 – $166 |
| 3 | Devoted 4684_medicare advantage devoted health inpatient 20251001 other · inpatient | $166 | $166 | — | — | — | $166 – $166 |
| 4 | Devoted 4918_medicare advantage devoted health outpatient 20250811 other · outpatient | $166 | $166 | — | — | — | $166 – $166 |
| 5 | Humana 4661_medicare advantage humana inpatient (aus,hay,nw,sw) 20251001 other · inpatient | $166 | $166 | — | — | — | $166 – $166 |
| 6 | Humana 4921_medicare advantage humana outpatient (aus,hay,nw,sw.smv) 20250811 other · outpatient | $166 | $166 | — | — | — | $166 – $166 |
| 7 | Tricare 4696_tricare inpatient 20251001 other · inpatient | $166 | $166 | — | — | — | $166 – $166 |
| 8 | WellCare 4691_medicare advantage wellcare inpatient 20251001 other · inpatient | $166 | $166 | — | — | — | $166 – $166 |
| 9 | WellCare 4929_medicare advantage wellcare outpatient 20250811 other · outpatient | $166 | $166 | — | — | — | $166 – $166 |
| 10 | UnitedHealthcare 4687_medicare advantage united healthcare inpatient (aus,nw,sw,hay) 20251001 other · inpatient | $169 | $169 | — | — | — | $169 – $169 |
| 11 | UnitedHealthcare 4928_medicare advantage united healthcare outpatient (aus,nw,sw,hay,smv) 20250811 other · outpatient | $169 | $169 | — | — | — | $169 – $169 |
| 12 | Tricare 1229_tricare cah outpatient 20170101 fee schedule · outpatient | $202 | $202 | — | — | — | $202 – $202 |
| 13 | Blue Cross Blue Shield 4127_blue cross blue shield bav exchange 20250101 fee schedule · outpatient | $273 | $273 | — | — | — | $273 – $273 |
| 14 | Ambetter 4652_superior ambetter inpatient 20251001 other · inpatient | $299 | $299 | — | — | — | $299 – $299 |
| 15 | Ambetter 4960_superior ambetter outpatient 20250811 other · outpatient | $299 | $299 | — | — | — | $299 – $299 |
| 16 | Cigna 4475_cigna hmo (aus,nw,sw,hay) 20250701 fee schedule · both | $684 | $539 | $182 | 34% | — | $311 – $684 |
| 17 | Blue Cross Blue Shield 4440_blue cross blue shield hpn 20250501 fee schedule · outpatient | $554 | $554 | — | — | — | $554 – $554 |
| 18 | Blue Cross Blue Shield 4497_blue cross blue shield hpn (dell, williamson,hays) 20250501 fee schedule · outpatient | $554 | $554 | — | — | — | $554 – $554 |
| 19 | Blue Cross Blue Shield 4095_blue cross blue shield hmo essentials 20250101 fee schedule · outpatient | $611 | $611 | — | — | — | $611 – $611 |
| 20 | Humana 2668_humana hmo 20230701 other · outpatient | $629 | $629 | — | — | — | $629 – $629 |
| 21 | Blue Cross Blue Shield 4094_blue cross blue shield ppo 20250101 fee schedule · outpatient | $676 | $676 | — | — | — | $676 – $676 |
| 22 | Aetna 1377_aetna hmo exchange 20200101 fee schedule · outpatient | $683 | $683 | — | — | — | $683 – $683 |
| 23 | Cigna 4476_cigna hmo (wil,del) 20250701 fee schedule · outpatient | $684 | $684 | — | — | — | $684 – $684 |
| 24 | Aetna 4489_aetna aco hmo 20250801 fee schedule · both | $746 | $746 | — | — | — | $746 – $746 |
| 25 | Aetna 4490_aetna multi-tier whole health sha 20250801 fee schedule · both | $746 | $746 | — | — | — | $746 – $746 |
Last updated: Jan 1, 2026
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