CPT 95904
Low
$36
Average
$627
Median
$80
High
$13.9k
Each hospital's average Aetna rate, under the methodology and billing class chosen below.
26 hospitals; the 90th percentile is 3.0× the 10th. Each bar is a price range and its height is how many hospitals fall in it. Hover a bar, or a row in the ladder, for details.
Filter by billing methodology
Filter by billing class
32 hospital rates
iThe hospitals that file a Aetna rate for this code, one row per hospital and set of terms (billing class, payment method, setting). Rates under different terms are never blended, so the terms are shown under each hospital’s name. Figures are the hospital’s averages across its plans.| # | Plans | |||||||
|---|---|---|---|---|---|---|---|---|
| 1 | Cheshire Medical Center Keene, NH professional · fee schedule · outpatient | 1 | $73 | $73 | $20 | 27% | — | $54 – $93 |
| 2 | Cleveland Clinic Weston Hospital Nonprofit Corporation Weston, FL professional · percent of total billed charges · outpatientfrom % of charges | 1 | $186 | $166 | $76 | 46% | — | $64 – $247 |
| 3 | Covenant Medical Center Lubbock, TX fee schedule · outpatient | 1 | $142 | $142 | — | — | — | $142 – $142 |
| 4 | Covenant Medical Center Inc Saginaw, MI professional · fee schedule · both | 1 | $70 | $58 | $21 | 36% | — | $21 – $70 |
| 5 | Covenant Medical Center Inc Saginaw, MI professional · fee schedule · both | 1 | $70 | $58 | $21 | 36% | — | $21 – $70 |
| 6 | Deaconess Health System Gibson General Hospital Princeton, IN professional · percent of total billed charges · bothfrom % of charges | 1 | $88 | $88 | — | — | — | $88 – $88 |
| 7 | Deaconess Health System Henderson Hospital Henderson, KY professional · percent of total billed charges · bothfrom % of charges | 1 | $88 | $88 | — | — | — | $88 – $88 |
| 8 | Deaconess Health System Union County Hospital Morganfield, KY professional · percent of total billed charges · bothfrom % of charges | 1 | $88 | $88 | — | — | — | $88 – $88 |
| 9 | Deaconess Hospital, Inc Newburgh, IN professional · percent of total billed charges · bothfrom % of charges | 1 | $88 | $88 | — | — | — | $88 – $88 |
| 10 | Deaconess Hospital, Inc Newburgh, IN professional · percent of total billed charges · bothfrom % of charges | 1 | $88 | $88 | — | — | — | $88 – $88 |
| 11 | Deaconess Illinois Crossroads Inc Mount Vernon, IL professional · percent of total billed charges · bothfrom % of charges | 1 | $67 | $67 | $27 | 40% | — | $34 – $100 |
| 12 | Deaconess Illinois Union County Hospital Inc Anna, IL professional · percent of total billed charges · bothfrom % of charges | 1 | $59 | $59 | $24 | 40% | — | $30 – $88 |
| 13 | Deaconess Regional Healthcare Services Illinois Inc Marion, IL professional · percent of total billed charges · bothfrom % of charges | 1 | $66 | $66 | $26 | 40% | — | $33 – $98 |
| 14 | Doylestown Hospital Doylestown, PA facility · percent of total billed charges · outpatientfrom % of charges | 2 | $230 | $230 | $8 | 3% | — | $222 – $238 |
| 15 | Ellis Hospital NY 12308; 2210 Troy Schenectady Road Niskayuna, NY facility · percent of total billed charges · inpatientfrom % of charges | 1 | $128 | $185 | $87 | 47% | — | $119 – $307 |
| 16 | Ellis Hospital NY 12308; 2210 Troy Schenectady Road Niskayuna, NY facility · percent of total billed charges · outpatientfrom % of charges | 1 | $125 | $180 | $85 | 47% | — | $116 – $300 |
| 17 | Fairfield Medical Center 401 N Ewing St facility · fee schedule · outpatient | 1 | $13.9k | $13.9k | — | — | — | $13.9k – $13.9k |
| 18 | HCA FLORIDA LARGO WEST HOSPITAL LARGO, FL percent of total billed charges · outpatientfrom % of charges | 5 | $74 | $64 | $25 | 40% | — | $23 – $98 |
| 19 | HealthAlliance Hospital Kingston, NY facility · fee schedule · outpatient | 1 | $31 | $31 | — | — | — | $31 – $31 |
| 20 | HealthAlliance Hospital Kingston, NY facility · other · outpatient | 1 | $67 | $67 | — | — | — | $67 – $67 |
| 21 | HealthAlliance Hospital Kingston, NY facility · percent of total billed charges · outpatientfrom % of charges | 2 | $64 | $64 | $3 | 5% | — | $61 – $67 |
| 22 | Lubbock Heritage Hospital LLC Lubbock, TX fee schedule · outpatient | 1 | $142 | $142 | — | — | — | $142 – $142 |
| 23 | Margaretville Memorial Hospital Margaretville, NY facility · fee schedule · outpatient | 1 | $76 | $76 | — | — | — | $76 – $76 |
| 24 | Margaretville Memorial Hospital Margaretville, NY facility · other · outpatient | 1 | $67 | $67 | — | — | — | $67 – $67 |
| 25 | Margaretville Memorial Hospital Margaretville, NY facility · percent of total billed charges · outpatientfrom % of charges | 2 | $64 | $64 | $3 | 5% | — | $61 – $67 |
← Payers reporting CPT 95904 · Snapshot 20261113T090226Z-3ce6c0b8