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
MR MAM W R PEDI
Smithville, TX
See all hospitals reporting HCPCS C8903 →Price type
Ascension Seton’s median price of $637 is 109% above the median hospital's median price ($305), higher than 72% of the 1,344 hospitals reporting HCPCS C8903. The highlighted bar is where this hospital falls; shaded is the middle 50% of hospitals.
Negotiated rates from the hospital’s own file: 2 payers, 6 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 | Blue Cross Blue Shield 4127_blue cross blue shield bav exchange 20250101 fee schedule · outpatient | $182 | $182 | — | — | — | $182 – $182 |
| 2 | Tricare 1229_tricare cah outpatient 20170101 fee schedule · outpatient | $439 | $439 | — | — | — | $439 – $439 |
| 3 | Blue Cross Blue Shield 4440_blue cross blue shield hpn 20250501 fee schedule · outpatient | $605 | $605 | — | — | — | $605 – $605 |
| 4 | Blue Cross Blue Shield 4497_blue cross blue shield hpn (dell, williamson,hays) 20250501 fee schedule · outpatient | $605 | $605 | — | — | — | $605 – $605 |
| 5 | Blue Cross Blue Shield 4095_blue cross blue shield hmo essentials 20250101 fee schedule · outpatient | $669 | $669 | — | — | — | $669 – $669 |
| 6 | Blue Cross Blue Shield 4094_blue cross blue shield ppo 20250101 fee schedule · outpatient | $738 | $738 | — | — | — | $738 – $738 |
Last updated: Jan 1, 2026
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