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 Anthem 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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15 hospital rates
| # | Plans | |||
|---|---|---|---|---|
| 1 | Benefis Hospitals Inc Helena, MT fee schedule · inpatient | 1 | $0.01 | $0.01 – $0.01 |
| 2 | Benefis Senior Services Great Falls, MT fee schedule · both | 1 | $0.01 | $0.01 – $0.01 |
| 3 | Blue Hill Memorial Hospital Hill, ME professional · fee schedule · outpatient | 2 | $2.88 | $2.88 – $2.88 |
| 4 | Charles A. Dean Memorial Hospital Greenville, ME professional · fee schedule · outpatient | 2 | $2.88 | $2.88 – $2.88 |
| 5 | Covenant Medical Center Inc Saginaw, MI facility · fee schedule · outpatient | 1 | $17.32 | $17.32 – $17.32 |
| 6 | Covenant Medical Center Inc Saginaw, MI facility · fee schedule · outpatient | 1 | $17.32 | $17.32 – $17.32 |
| 7 | Eastern Maine Medical Center Bangor, ME professional · fee schedule · outpatient | 2 | $2.88 | $2.88 – $2.88 |
| 8 | Maine Coast Regional Health Facilities Ellsworth, ME professional · fee schedule · outpatient | 2 | $2.88 | $2.88 – $2.88 |
| 9 | Mayo Regional Hospital Dover Foxcroft, ME professional · fee schedule · outpatient | 1 | $2.88 | $2.88 – $2.88 |
| 10 | Mercy Hospital Portland, ME professional · fee schedule · outpatient | 2 | $2.88 | $2.88 – $2.88 |
| 11 | Nationwide Children's Hospital Columbus, OH facility · fee schedule · outpatient | 1 | $8.74 | $8.74 – $8.74 |
| 12 | Norton Kings Daughters Health Inc Madison, IN professional · fee schedule · both | 1 | $6.24 | $6.24 – $6.24 |
| 13 | Saint Elizabeth’s Hospital of Wabasha Inc Wabasha, MN facility · fee schedule · outpatient | 1 | $9.46 | $9.46 – $9.46 |
| 14 | Sebasticook Valley Health Pittsfield, ME professional · fee schedule · outpatient | 2 | $2.88 | $2.88 – $2.88 |
| 15 | The Aroostook Medical Center Isle, ME professional · fee schedule · outpatient | 2 | $2.88 | $2.88 – $2.88 |
← Payers reporting HCPCS A0021 · Snapshot 20261108T203506Z-bb90dbab