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
REVASC INTRA LITHOTRIP-STENT
San Augustine, TX
See all hospitals reporting HCPCS C9765 →Price type
Memorial Medical Center San Augustine’s median price of $18.2k is 4% below the median hospital's median price ($18.9k), higher than 41% of the 1,757 hospitals reporting HCPCS C9765. The highlighted bar is where this hospital falls; shaded is the middle 50% of hospitals.
Negotiated rates from the hospital’s own file: 8 payers, 23 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 | Cigna commercial|all plans case rate · outpatient | $3.3k | $3.3k | — | — | — | $3.3k – $3.3k |
| 2 | Blue Cross Blue Shield commercial|blue advantage hmo case rate · outpatient | $6.5k | $6.5k | — | — | — | $6.5k – $6.5k |
| 3 | UnitedHealthcare commercial|exchange fee schedule · outpatient | $11.8k | $11.8k | — | — | — | $11.8k – $11.8k |
| 4 | Blue Cross Blue Shield commercial|blue premier case rate · outpatient | $14.6k | $14.6k | — | — | — | $14.6k – $14.6k |
| 5 | Blue Cross Blue Shield commercial|hmo case rate · outpatient | $14.9k | $14.9k | — | — | — | $14.9k – $14.9k |
| 6 | UnitedHealthcare commercial|all other plans fee schedule · outpatient | $15.1k | $15.1k | — | — | — | $15.1k – $15.1k |
| 7 | Aetna medicare|all plans case rate · outpatient | $15.5k | $15.5k | — | — | — | $15.5k – $15.5k |
| 8 | Humana medicare|all plans case rate · outpatient | $15.5k | $15.5k | — | — | — | $15.5k – $15.5k |
| 9 | Cigna Healthspring medicare|all other plans case rate · outpatient | $16.2k | $16.2k | — | — | — | $16.2k – $16.2k |
| 10 | Blue Cross Blue Shield commercial|ppo case rate · outpatient | $16.3k | $16.3k | — | — | — | $16.3k – $16.3k |
| 11 | Cigna Healthspring medicare|ppo case rate · outpatient | $16.4k | $16.4k | — | — | — | $16.4k – $16.4k |
| 12 | Aetna commercial|all plans fee schedule · inpatient | $16.4k | $16.4k | — | — | — | $16.4k – $16.4k |
| 13 | Aetna commercial|all plans fee schedule · outpatient | $16.4k | $16.4k | — | — | — | $16.4k – $16.4k |
| 14 | Blue Cross Blue Shield medicare|all plans case rate · outpatient | $17.8k | $17.8k | — | — | — | $17.8k – $17.8k |
| 15 | UnitedHealthcare medicare|all plans case rate · outpatient | $17.8k | $17.8k | — | — | — | $17.8k – $17.8k |
| 16 | Phcs commercial|all plans fee schedule · outpatient | $44.6k | $44.6k | — | — | — | $44.6k – $44.6k |
| 17 | Humana commercial|all plans fee schedule · inpatient | $45.9k | $45.9k | — | — | — | $45.9k – $45.9k |
| 18 | Humana commercial|all plans fee schedule · outpatient | $45.9k | $45.9k | — | — | — | $45.9k – $45.9k |
| 19 | MultiPlan commercial|all plans fee schedule · inpatient | $45.9k | $45.9k | — | — | — | $45.9k – $45.9k |
| 20 | MultiPlan commercial|all plans fee schedule · outpatient | $45.9k | $45.9k | — | — | — | $45.9k – $45.9k |
| 21 | Phcs commercial|all plans fee schedule · inpatient | $52.5k | $52.5k | — | — | — | $52.5k – $52.5k |
| 22 | UnitedHealthcare commercial|exchange fee schedule · inpatient | $65.6k | $65.6k | — | — | — | $65.6k – $65.6k |
| 23 | UnitedHealthcare medicaid|starplus fee schedule · outpatient | $105.7k | $105.7k | — | — | — | $105.7k – $105.7k |
Last updated: Feb 28, 2026
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