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
DEFIBRILLATOR CARDIAC EMBLEM MRI S-ICD D12.7 MM W83.1 MM X H69.1 MM 130 GM
Quitman, TX
See all hospitals reporting HCPCS C1722 →Price type
Quitman Hospital, LLC’s median price of $12.9k is 43% below the median hospital's median price ($22.6k), higher than 20% of the 1,352 hospitals reporting HCPCS C1722. The highlighted bar is where this hospital falls; shaded is the middle 50% of hospitals.
Negotiated rates from the hospital’s own file: 10 payers, 29 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 blue cross medicare advantage oos [116005] facility · percent of total billed charges · bothfrom % of charges | $5.8k | $6.5k | $2.9k | 45% | — | $3.4k – $11.7k |
| 2 | Cigna cigna medicare replacement [126500] facility · percent of total billed charges · bothfrom % of charges | $5.8k | $6.5k | $2.9k | 45% | — | $3.4k – $11.7k |
| 3 | Humana humana medicare advantage/ppo/gold [152503] facility · percent of total billed charges · bothfrom % of charges | $5.8k | $6.5k | $2.9k | 45% | — | $3.4k – $11.7k |
| 4 | Medicare medicare part a and b [163500] facility · percent of total billed charges · bothfrom % of charges | $5.8k | $6.5k | $2.9k | 45% | — | $3.4k – $11.7k |
| 5 | Medicare medicare part a only [163502] facility · percent of total billed charges · bothfrom % of charges | $5.8k | $6.5k | $2.9k | 45% | — | $3.4k – $11.7k |
| 6 | Medicare medicare part b only [163501] facility · percent of total billed charges · bothfrom % of charges | $5.8k | $6.5k | $2.9k | 45% | — | $3.4k – $11.7k |
| 7 | WellCare wellcare medicare [377501] facility · percent of total billed charges · bothfrom % of charges | $5.8k | $6.5k | $2.9k | 45% | — | $3.4k – $11.7k |
| 8 | Aetna aetna coventry medicare replacement [102002] facility · percent of total billed charges · bothfrom % of charges | $5.9k | $6.7k | $3.0k | 45% | — | $3.5k – $11.9k |
| 9 | UnitedHealthcare uhc medicare advantage [206511] facility · percent of total billed charges · bothfrom % of charges | $5.9k | $6.7k | $3.0k | 45% | — | $3.5k – $11.9k |
| 10 | Ambetter ambetter [293000] facility · percent of total billed charges · bothfrom % of charges | $6.6k | $7.5k | $3.3k | 45% | — | $3.9k – $13.3k |
| 11 | Healthcare Highways hch 90 degree benefits [221013] facility · percent of total billed charges · bothfrom % of charges | $10.4k | $11.7k | $5.2k | 45% | — | $6.1k – $20.8k |
| 12 | Healthcare Highways hch broken arrow [221012] facility · percent of total billed charges · bothfrom % of charges | $10.4k | $11.7k | $5.2k | 45% | — | $6.1k – $20.8k |
| 13 | Healthcare Highways hch john soules foods [221011] facility · percent of total billed charges · bothfrom % of charges | $10.4k | $11.7k | $5.2k | 45% | — | $6.1k – $20.8k |
| 14 | Blue Cross Blue Shield blue cross hmo of texas [115504] facility · percent of total billed charges · bothfrom % of charges | $12.1k | $13.7k | $6.1k | 45% | — | $7.2k – $24.4k |
| 15 | Blue Cross Blue Shield bcbs medicaid [116504] facility · percent of total billed charges · bothfrom % of charges | $13.8k | $15.5k | $7.0k | 45% | — | $8.2k – $27.8k |
| 16 | Cigna cigna healthspring medicaid replacement [394500] facility · percent of total billed charges · bothfrom % of charges | $13.8k | $15.5k | $7.0k | 45% | — | $8.2k – $27.8k |
| 17 | UnitedHealthcare uhc medicaid community plan [375501] facility · percent of total billed charges · bothfrom % of charges | $13.8k | $15.5k | $7.0k | 45% | — | $8.2k – $27.8k |
| 18 | Blue Cross Blue Shield blue cross advantage hmo of texas [115525] facility · percent of total billed charges · bothfrom % of charges | $14.0k | $15.8k | $7.1k | 45% | — | $8.3k – $28.2k |
| 19 | Blue Cross Blue Shield blue cross preferred ppo of texas [115526] facility · percent of total billed charges · bothfrom % of charges | $16.6k | $18.6k | $8.4k | 45% | — | $9.8k – $33.3k |
| 20 | Blue Cross Blue Shield blue cross traditional of texas [115503] facility · percent of total billed charges · bothfrom % of charges | $16.6k | $18.6k | $8.4k | 45% | — | $9.8k – $33.3k |
| 21 | UnitedHealthcare uhc medica choice [206030] facility · percent of total billed charges · bothfrom % of charges | $20.7k | $23.3k | $10.4k | 45% | — | $12.2k – $41.7k |
| 22 | UnitedHealthcare united healthcare student svc [206012] facility · percent of total billed charges · bothfrom % of charges | $20.7k | $23.3k | $10.4k | 45% | — | $12.2k – $41.7k |
| 23 | UnitedHealthcare united healthcare texas exchange plan [206034] facility · percent of total billed charges · bothfrom % of charges | $20.7k | $23.3k | $10.4k | 45% | — | $12.2k – $41.7k |
| 24 | Cigna cigna ppo [126025] facility · percent of total billed charges · bothfrom % of charges | $23.6k | $26.5k | $11.9k | 45% | — | $13.9k – $47.4k |
| 25 | Cigna cigna - great west [126009] facility · percent of total billed charges · bothfrom % of charges | $27.7k | $31.2k | $14.0k | 45% | — | $16.4k – $55.9k |
Last updated: Feb 12, 2026
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