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
MEMB SEPRAFILM ADHEN BARR 5X6 4301-02
Garrison, ND
See all hospitals reporting HCPCS C1765 →Price type
Garrison Memorial Hospital’s median price of $928 is 9% above the median hospital's median price ($847), higher than 55% of the 1,283 hospitals reporting HCPCS C1765. The highlighted bar is where this hospital falls; shaded is the middle 50% of hospitals.
Negotiated rates from the hospital’s own file: 6 payers, 13 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 | Humana medicare|all plans fee schedule · outpatient | $546 | $546 | — | — | — | $546 – $546 |
| 2 | Medica medicare|all plans fee schedule · outpatient | $546 | $546 | — | — | — | $546 – $546 |
| 3 | UnitedHealthcare medicare|all plans fee schedule · outpatient | $546 | $546 | — | — | — | $546 – $546 |
| 4 | Blue Cross Blue Shield medicare|all plans fee schedule · outpatient | $557 | $557 | — | — | — | $557 – $557 |
| 5 | UnitedHealthcare commercial|all plans fee schedule · inpatient | $808 | $808 | — | — | — | $808 – $808 |
| 6 | UnitedHealthcare commercial|all plans fee schedule · outpatient | $808 | $808 | — | — | — | $808 – $808 |
| 7 | Blue Cross Blue Shield medicaid|all plans fee schedule · outpatient | $950 | $950 | — | — | — | $950 – $950 |
| 8 | Medica commercial|all plans fee schedule · inpatient | $950 | $950 | — | — | — | $950 – $950 |
| 9 | Medica commercial|all plans fee schedule · outpatient | $950 | $950 | — | — | — | $950 – $950 |
| 10 | MultiPlan commercial|all plans fee schedule · inpatient | $982 | $982 | — | — | — | $982 – $982 |
| 11 | MultiPlan commercial|all plans fee schedule · outpatient | $982 | $982 | — | — | — | $982 – $982 |
| 12 | Sanford Health Plan commercial|all plans fee schedule · inpatient | $1.0k | $1.0k | — | — | — | $1.0k – $1.0k |
| 13 | Sanford Health Plan commercial|all plans fee schedule · outpatient | $1.0k | $1.0k | — | — | — | $1.0k – $1.0k |
Last updated: Feb 28, 2026
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