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 300 U IMSQ
Austin, TX
See all hospitals reporting CPT 90376 →Price type
St.davids Surgical Hospital’s median price of $857 is 68% above the median hospital's median price ($512), higher than 74% 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 | Superior Healthplan chip percent of total billed charges · outpatientfrom % of charges | $186 | $186 | — | — | — | $186 – $186 |
| 2 | Superior Healthplan chpfc percent of total billed charges · outpatientfrom % of charges | $186 | $186 | — | — | — | $186 – $186 |
| 3 | Superior Healthplan star percent of total billed charges · outpatientfrom % of charges | $186 | $186 | — | — | — | $186 – $186 |
| 4 | Superior Healthplan starplus percent of total billed charges · outpatientfrom % of charges | $186 | $186 | — | — | — | $186 – $186 |
| 5 | UnitedHealthcare narrownetworkhix fee schedule · outpatient | $430 | $430 | — | — | — | $430 – $430 |
| 6 | Blue Cross Blue Shield blueadvantage fee schedule · outpatient | $542 | $542 | — | — | — | $542 – $542 |
| 7 | Blue Cross Blue Shield mybluehealth fee schedule · outpatient | $542 | $542 | — | — | — | $542 – $542 |
| 8 | UnitedHealthcare allpayerappendix fee schedule · outpatient | $582 | $582 | — | — | — | $582 – $582 |
| 9 | UnitedHealthcare smallgroup fee schedule · outpatient | $582 | $582 | — | — | — | $582 – $582 |
| 10 | Superior Healthplan ambetterepo percent of total billed charges · outpatientfrom % of charges | $633 | $633 | — | — | — | $633 – $633 |
| 11 | Superior Healthplan ambetterhmo percent of total billed charges · outpatientfrom % of charges | $633 | $633 | — | — | — | $633 – $633 |
| 12 | Superior Healthplan valuehmo percent of total billed charges · outpatientfrom % of charges | $633 | $633 | — | — | — | $633 – $633 |
| 13 | Blue Cross Blue Shield blueessentials fee schedule · outpatient | $857 | $857 | — | — | — | $857 – $857 |
| 14 | Blue Cross Blue Shield blueessentialsaccess fee schedule · outpatient | $857 | $857 | — | — | — | $857 – $857 |
| 15 | Blue Cross Blue Shield eposoa fee schedule · outpatient | $922 | $922 | — | — | — | $922 – $922 |
| 16 | UnitedHealthcare optionsppo percent of total billed charges · outpatientfrom % of charges | $927 | $927 | — | — | — | $927 – $927 |
| 17 | Blue Cross Blue Shield ppo fee schedule · outpatient | $986 | $986 | — | — | — | $986 – $986 |
| 18 | Humana hmo percent of total billed charges · outpatientfrom % of charges | $1.0k | $1.0k | — | — | — | $1.0k – $1.0k |
| 19 | Humana ppo percent of total billed charges · outpatientfrom % of charges | $1.0k | $1.0k | — | — | — | $1.0k – $1.0k |
| 20 | Blue Cross Blue Shield traditional percent of total billed charges · outpatientfrom % of charges | $1.1k | $1.1k | — | — | — | $1.1k – $1.1k |
| 21 | UnitedHealthcare globalbenefitplan percent of total billed charges · outpatientfrom % of charges | $1.7k | $1.7k | — | — | — | $1.7k – $1.7k |
| 22 | First Health ppo percent of total billed charges · outpatientfrom % of charges | $2.5k | $2.4k | $201 | 8% | — | $2.1k – $2.6k |
| 23 | MultiPlan phcsprimarynetwork percent of total billed charges · outpatientfrom % of charges | $2.8k | $2.8k | — | — | — | $2.8k – $2.8k |
| 24 | MultiPlan complementarynetwork percent of total billed charges · outpatientfrom % of charges | $3.2k | $3.2k | — | — | — | $3.2k – $3.2k |
Last updated: Sep 1, 2026
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