Hodge pessary without support, size 4 at Samaritan Hospital

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.

Model: claude-haiku-5-5
Provider: anthropic
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Max output tokens: 4096
Prompt version (hash): 444523875572
Generated: October 20, 2026

Original text from hospital filings

PR Pessary Reusable Non Rubber Any Type

Troy, NY

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Pricing by billing methodology

Price type

How this price compares nationally

Samaritan Hospital’s median price of $75 is about the same as the median hospital's median price ($75), higher than 51% of the 1,062 hospitals reporting HCPCS A4562. The highlighted bar is where this hospital falls; shaded is the middle 50% of hospitals.

Payers reporting HCPCS A4562 at Samaritan Hospital

Negotiated rates from the hospital’s own file: 34 payers, 62 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 aetna facility · percent of total billed charges · bothfrom % of charges	$35	$37	$5	13%	—	$33 – $44
2	Blue Cross Blue Shield blue shield of ne new york hmo facility · percent of total billed charges · bothfrom % of charges	$35	$37	$5	13%	—	$33 – $44
3	Blue Cross Blue Shield blue shield of ne new york ppo facility · percent of total billed charges · bothfrom % of charges	$35	$37	$5	13%	—	$33 – $44
4	Carefirst blue shield of ne new york hmo facility · percent of total billed charges · bothfrom % of charges	$35	$37	$5	13%	—	$33 – $44
5	Carefirst blue shield of ne new york ppo facility · percent of total billed charges · bothfrom % of charges	$35	$37	$5	13%	—	$33 – $44
6	Cigna cigna facility · percent of total billed charges · bothfrom % of charges	$35	$37	$5	13%	—	$33 – $44
7	Excellus blue shield of ne new york ppo facility · percent of total billed charges · bothfrom % of charges	$35	$37	$5	13%	—	$33 – $44
8	Highmark blue shield of ne new york ascend facility · percent of total billed charges · bothfrom % of charges	$35	$37	$5	13%	—	$33 – $44
9	Highmark blue shield of ne new york hmo facility · percent of total billed charges · bothfrom % of charges	$35	$37	$5	13%	—	$33 – $44
10	Highmark blue shield of ne new york ppo facility · percent of total billed charges · bothfrom % of charges	$35	$37	$5	13%	—	$33 – $44
11	Medical Mutual aetna facility · percent of total billed charges · bothfrom % of charges	$35	$37	$5	13%	—	$33 – $44
12	Premera blue shield of ne new york ppo facility · percent of total billed charges · bothfrom % of charges	$35	$37	$5	13%	—	$33 – $44
13	Regence blue shield of ne new york ppo facility · percent of total billed charges · bothfrom % of charges	$35	$37	$5	13%	—	$33 – $44
14	UnitedHealthcare uhc essential plan medicaid facility · percent of total billed charges · bothfrom % of charges	$35	$37	$5	13%	—	$33 – $44
15	UnitedHealthcare united healthcare medicaid harp chip facility · percent of total billed charges · bothfrom % of charges	$35	$37	$5	13%	—	$33 – $44
16	Wellmark blue shield of ne new york hmo facility · percent of total billed charges · bothfrom % of charges	$35	$37	$5	13%	—	$33 – $44
17	Wellmark blue shield of ne new york ppo facility · percent of total billed charges · bothfrom % of charges	$35	$37	$5	13%	—	$33 – $44
18	Humana tricare professional · percent of total billed charges · bothfrom % of charges	$60	$60	—	—	—	$60 – $60
19	Tricare tricare professional · percent of total billed charges · bothfrom % of charges	$60	$60	—	—	—	$60 – $60
20	Aetna aetna medicare advantage professional · fee schedule · both	$71	$71	—	—	—	$71 – $71
21	UnitedHealthcare united healthcare facility · percent of total billed charges · bothfrom % of charges	$72	$72	$23	32%	—	$45 – $110
22	First Health first health facility · percent of total billed charges · bothfrom % of charges	$69	$74	$10	13%	—	$66 – $88
23	Aetna pb xr 100% default professional · percent of total billed charges · bothfrom % of charges	$75	$75	—	—	—	$75 – $75
24	Ambetter pb xr 100% default professional · percent of total billed charges · bothfrom % of charges	$75	$75	—	—	—	$75 – $75
25	Amerihealth Caritas pb xr 100% default professional · percent of total billed charges · bothfrom % of charges	$75	$75	—	—	—	$75 – $75

Page 1 of 3 · 62 rates

Last updated: Mar 31, 2026

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