ON-Q pain relief pump, double silver type 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-sonnet-5-5
Provider: anthropic
API: message_batches
Reasoning effort: model default
Max output tokens: 4096
Prompt version (hash): 444523875572
Generated: October 20, 2026

Original text from hospital filings

PUMP ON Q DEL SYS 5ML/HR

Troy, NY

See all hospitals reporting HCPCS C9804 →

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Pricing by billing methodology

Price type

How this price compares nationally

Samaritan Hospital’s median price of $117 is 80% below the median hospital's median price ($589), higher than 5% of the 399 hospitals reporting HCPCS C9804. The highlighted bar is where this hospital falls; shaded is the middle 50% of hospitals.

Payers reporting HCPCS C9804 at Samaritan Hospital

Negotiated rates from the hospital’s own file: 15 payers, 26 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	$95	$89	$13	15%	—	$67 – $101
2	Medical Mutual aetna facility · percent of total billed charges · bothfrom % of charges	$95	$89	$13	15%	—	$67 – $101
3	UnitedHealthcare uhc essential plan medicaid facility · percent of total billed charges · bothfrom % of charges	$99	$116	$40	35%	—	$67 – $201
4	UnitedHealthcare united healthcare medicaid harp chip facility · percent of total billed charges · bothfrom % of charges	$99	$116	$40	35%	—	$67 – $201
5	Blue Cross Blue Shield blue shield of ne new york hmo facility · percent of total billed charges · bothfrom % of charges	$109	$142	$67	47%	—	$67 – $276
6	Blue Cross Blue Shield blue shield of ne new york ppo facility · percent of total billed charges · bothfrom % of charges	$109	$142	$67	47%	—	$67 – $276
7	Carefirst blue shield of ne new york hmo facility · percent of total billed charges · bothfrom % of charges	$109	$142	$67	47%	—	$67 – $276
8	Carefirst blue shield of ne new york ppo facility · percent of total billed charges · bothfrom % of charges	$109	$142	$67	47%	—	$67 – $276
9	Excellus blue shield of ne new york ppo facility · percent of total billed charges · bothfrom % of charges	$109	$142	$67	47%	—	$67 – $276
10	Highmark blue shield of ne new york ascend facility · percent of total billed charges · bothfrom % of charges	$109	$142	$67	47%	—	$67 – $276
11	Highmark blue shield of ne new york hmo facility · percent of total billed charges · bothfrom % of charges	$109	$142	$67	47%	—	$67 – $276
12	Highmark blue shield of ne new york ppo facility · percent of total billed charges · bothfrom % of charges	$109	$142	$67	47%	—	$67 – $276
13	Premera blue shield of ne new york ppo facility · percent of total billed charges · bothfrom % of charges	$109	$142	$67	47%	—	$67 – $276
14	Regence blue shield of ne new york ppo facility · percent of total billed charges · bothfrom % of charges	$109	$142	$67	47%	—	$67 – $276
15	Wellmark blue shield of ne new york hmo facility · percent of total billed charges · bothfrom % of charges	$109	$142	$67	47%	—	$67 – $276
16	Wellmark blue shield of ne new york ppo facility · percent of total billed charges · bothfrom % of charges	$109	$142	$67	47%	—	$67 – $276
17	Cigna cigna facility · percent of total billed charges · bothfrom % of charges	$141	$195	$123	63%	—	$67 – $427
18	UnitedHealthcare united healthcare facility · percent of total billed charges · bothfrom % of charges	$207	$224	$104	47%	—	$91 – $503
19	First Health first health facility · percent of total billed charges · bothfrom % of charges	$198	$231	$81	35%	—	$133 – $402
20	MultiPlan beech street facility · percent of total billed charges · bothfrom % of charges	$223	$260	$91	35%	—	$150 – $452
21	MultiPlan multiplan facility · percent of total billed charges · bothfrom % of charges	$223	$260	$91	35%	—	$150 – $452
22	Phcs multiplan facility · percent of total billed charges · bothfrom % of charges	$223	$260	$91	35%	—	$150 – $452
23	Anthem empire medicaid facility · percent of total billed charges · bothfrom % of charges	$247	$289	$101	35%	—	$166 – $503
24	Anthem empire medicaid essential 1 2 3 4 facility · percent of total billed charges · bothfrom % of charges	$247	$289	$101	35%	—	$166 – $503
25	Excellus empire medicaid facility · percent of total billed charges · bothfrom % of charges	$247	$289	$101	35%	—	$166 – $503

Page 1 of 2 · 26 rates

Last updated: Mar 31, 2026

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