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
Outside state ambulance serv
The 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.
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87 hospital rates
| # | Plans | |||
|---|---|---|---|---|
| 1 | Abington Memorial Hospital Abington, PA facility · fee schedule · outpatient | 2 | $13.82 | $13.10 – $14.54 |
| 2 | Acadia Hospital Bangor, ME professional · fee schedule · outpatient | 1 | $6.60 | $6.60 – $6.60 |
| 3 | Allen Memorial Hospital Corporation Waterloo, IA fee schedule · both | 2 | $8.12 | $8.04 – $8.20 |
| 4 | Alta Newport Hospital, LLC Tustin, CA facility · case rate · outpatient | 2 | $18.57 | $18.57 – $18.57 |
| 5 | Benefis Hospitals Inc Helena, MT fee schedule · inpatient | 1 | $0.01 | $0.01 – $0.01 |
| 6 | Benefis Hospitals Inc Helena, MT percent of total billed charges · bothfrom % of charges | 1 | $19,383 | $19,383 – $19,383 |
| 7 | Benefis Senior Services Great Falls, MT fee schedule · both | 1 | $0.01 | $0.01 – $0.01 |
| 8 | Berger Hospital Circleville, OH fee schedule · outpatient | 1 | $15.57 | $15.57 – $15.57 |
| 9 | Bethesda Hospital Inc. Lebanon, OH facility · fee schedule · outpatient | 1 | $15.69 | $15.54 – $15.84 |
| 10 | Blue Hill Memorial Hospital Hill, ME professional · fee schedule · outpatient | 1 | $6.60 | $6.60 – $6.60 |
| 11 | Boulder Community Health Lafayette, CO professional · fee schedule · both | 2 | $8.63 | $6.67 – $12.54 |
| 12 | Broaddus Hospital Association Inc Philippi, WV professional · fee schedule · both | 1 | $6.20 | $6.20 – $6.20 |
| 13 | Butler Healthcare Providers_ DBA Butler Memorial Hospital Butler, PA facility · fee schedule · outpatient | 1 | $13.80 | $13.80 – $13.80 |
| 14 | CHRISTUS Good Shepherd Hospital - Northpark Longview, TX fee schedule · outpatient | 1 | $6.28 | $6.28 – $6.28 |
| 15 | Central Iowa Hospital Corporation Des Moines, IA fee schedule · both | 2 | $8.04 | $8.04 – $8.04 |
| 16 | Central Iowa Hospital Corporation West Des Moines, IA fee schedule · both | 2 | $8.04 | $8.04 – $8.04 |
| 17 | Charles A. Dean Memorial Hospital Greenville, ME professional · fee schedule · outpatient | 1 | $6.60 | $6.60 – $6.60 |
| 18 | Cheshire Medical Center Keene, NH professional · fee schedule · outpatient | 2 | $9.50 | $6.27 – $12.73 |
| 19 | Clarion Hospital Clarion, PA facility · fee schedule · outpatient | 1 | $15.98 | $15.98 – $15.98 |
| 20 | Cleveland Clinic Weston Hospital Nonprofit Corporation Weston, FL facility · fee schedule · outpatient | 1 | $6.10 | $6.10 – $6.10 |
| 21 | Clinton Memorial Hospital Wilmington, OH fee schedule · outpatient | 1 | $15.69 | $15.54 – $15.84 |
| 22 | Conway Hospital, Inc. Conway, SC professional · fee schedule · outpatient | 1 | $275.00 | $275.00 – $275.00 |
| 23 | Covenant Medical Center Lubbock, TX fee schedule · outpatient | 1 | $33.41 | $33.41 – $33.41 |
| 24 | Davis Medical Center Elkins, WV professional · fee schedule · both | 1 | $6.20 | $6.20 – $6.20 |
| 25 | Denver Health and Hospital Authority Denver, CO facility · fee schedule · outpatient | 1 | $11.57 | $11.57 – $11.57 |
← Payers reporting HCPCS A0021 · Snapshot 20261108T203506Z-bb90dbab