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
RIG IMOGAM-HT 1500U IMSQ
Georgetown, TX
See all hospitals reporting CPT 90376 →Price type
St. David's Georgetown Hospital’s median price of $3.7k is 630% above the median hospital's median price ($512), higher than 98% of the 1,368 hospitals reporting CPT 90376. 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, 24 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 | UnitedHealthcare narrownetworkhix fee schedule · outpatient | $430 | $430 | — | — | — | $430 – $430 |
| 2 | Blue Cross Blue Shield blueadvantage fee schedule · outpatient | $542 | $542 | — | — | — | $542 – $542 |
| 3 | Blue Cross Blue Shield mybluehealth fee schedule · outpatient | $542 | $542 | — | — | — | $542 – $542 |
| 4 | UnitedHealthcare allpayerappendix fee schedule · outpatient | $582 | $582 | — | — | — | $582 – $582 |
| 5 | UnitedHealthcare smallgroup fee schedule · outpatient | $582 | $582 | — | — | — | $582 – $582 |
| 6 | Superior Healthplan chip percent of total billed charges · outpatientfrom % of charges | $750 | $750 | — | — | — | $750 – $750 |
| 7 | Superior Healthplan chpfc percent of total billed charges · outpatientfrom % of charges | $750 | $750 | — | — | — | $750 – $750 |
| 8 | Superior Healthplan star percent of total billed charges · outpatientfrom % of charges | $750 | $750 | — | — | — | $750 – $750 |
| 9 | Superior Healthplan starplus percent of total billed charges · outpatientfrom % of charges | $750 | $750 | — | — | — | $750 – $750 |
| 10 | Blue Cross Blue Shield blueessentials fee schedule · outpatient | $857 | $857 | — | — | — | $857 – $857 |
| 11 | Blue Cross Blue Shield blueessentialsaccess fee schedule · outpatient | $857 | $857 | — | — | — | $857 – $857 |
| 12 | Blue Cross Blue Shield eposoa fee schedule · outpatient | $922 | $922 | — | — | — | $922 – $922 |
| 13 | Blue Cross Blue Shield ppo fee schedule · outpatient | $986 | $986 | — | — | — | $986 – $986 |
| 14 | Superior Healthplan ambetterepo percent of total billed charges · outpatientfrom % of charges | $2.5k | $2.5k | — | — | — | $2.5k – $2.5k |
| 15 | Superior Healthplan ambetterhmo percent of total billed charges · outpatientfrom % of charges | $2.5k | $2.5k | — | — | — | $2.5k – $2.5k |
| 16 | Superior Healthplan valuehmo percent of total billed charges · outpatientfrom % of charges | $2.5k | $2.5k | — | — | — | $2.5k – $2.5k |
| 17 | UnitedHealthcare optionsppo percent of total billed charges · outpatientfrom % of charges | $3.7k | $3.7k | — | — | — | $3.7k – $3.7k |
| 18 | Humana hmo percent of total billed charges · outpatientfrom % of charges | $4.2k | $4.2k | — | — | — | $4.2k – $4.2k |
| 19 | Humana ppo percent of total billed charges · outpatientfrom % of charges | $4.2k | $4.2k | — | — | — | $4.2k – $4.2k |
| 20 | Blue Cross Blue Shield traditional percent of total billed charges · outpatientfrom % of charges | $4.8k | $4.8k | — | — | — | $4.8k – $4.8k |
| 21 | UnitedHealthcare globalbenefitplan percent of total billed charges · outpatientfrom % of charges | $6.7k | $6.7k | — | — | — | $6.7k – $6.7k |
| 22 | First Health ppo percent of total billed charges · outpatientfrom % of charges | $10.1k | $9.7k | $824 | 8% | — | $8.6k – $10.5k |
| 23 | MultiPlan phcsprimarynetwork percent of total billed charges · outpatientfrom % of charges | $11.2k | $11.2k | — | — | — | $11.2k – $11.2k |
| 24 | MultiPlan complementarynetwork percent of total billed charges · outpatientfrom % of charges | $12.7k | $12.7k | — | — | — | $12.7k – $12.7k |
Last updated: Sep 1, 2026
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