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 Blue Cross Blue Shield 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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35 hospital rates
| # | Plans | |||
|---|---|---|---|---|
| 1 | Amisub of South Carolina, Inc. Fort Mill, SC fee schedule · outpatient | 4 | $0.74 | $0.29 – $1.00 |
| 2 | Benefis Hospitals Inc Helena, MT fee schedule · inpatient | 1 | $0.01 | $0.01 – $0.01 |
| 3 | Benefis Hospitals Inc Helena, MT percent of total billed charges · bothfrom % of charges | 4 | $17,571 | $15,801 – $18,118 |
| 4 | Benefis Hospitals Inc Helena, MT percent of total billed charges · inpatientfrom % of charges | 2 | $17,002 | $16,854 – $17,149 |
| 5 | Benefis Hospitals Inc Helena, MT percent of total billed charges · outpatientfrom % of charges | 2 | $14,084 | $13,694 – $14,474 |
| 6 | Benefis Senior Services Great Falls, MT fee schedule · both | 1 | $0.01 | $0.01 – $0.01 |
| 7 | Blessing Hospital Quincy, IL professional · fee schedule · both | 1 | $5.77 | $5.77 – $5.77 |
| 8 | Covenant Medical Center Inc Saginaw, MI facility · fee schedule · outpatient | 1 | $17.32 | $17.32 – $17.32 |
| 9 | Covenant Medical Center Inc Saginaw, MI facility · fee schedule · outpatient | 1 | $17.32 | $17.32 – $17.32 |
| 10 | Fairview Maple Grove Surgery Center Maple Grove, MN fee schedule · both | 1 | $9.88 | $9.88 – $9.88 |
| 11 | GILLETTE CHILDREN'S SPECIALTY HEALTHCARE PAUL, MN professional · fee schedule · outpatient | 1 | $8.84 | $8.84 – $8.84 |
| 12 | Henry Ford Health System West Bloomfield, MI facility · fee schedule · outpatient | 3 | $20.06 | $17.82 – $24.54 |
| 13 | Henry Ford Health System Plymouth, MI facility · fee schedule · outpatient | 3 | $31.97 | $24.54 – $35.69 |
| 14 | Henry Ford Macomb Hospital Corporation Clinton Twp, MI facility · fee schedule · outpatient | 3 | $18.53 | $15.53 – $24.54 |
| 15 | Henry Ford Wyandotte Hospital Brownstown Charter Twp., MI facility · fee schedule · outpatient | 3 | $20.15 | $17.95 – $24.54 |
| 16 | Kadlec Regional Medical Center Kennewick, WA fee schedule · outpatient | 1 | $10.90 | $10.90 – $10.90 |
| 17 | Kalkaska Memorial Health Center Kalkaska, MI professional · fee schedule · both | 1 | $10.17 | $10.17 – $10.17 |
| 18 | Munson Healthcare Cadillac Cadillac, MI facility · fee schedule · outpatient | 1 | $21.32 | $21.32 – $21.32 |
| 19 | Munson Healthcare Cadillac Cadillac, MI professional · fee schedule · both | 1 | $10.17 | $10.17 – $10.17 |
| 20 | Munson Healthcare Charlevoix Hospital Charlevoix, MI professional · fee schedule · both | 1 | $10.17 | $10.17 – $10.17 |
| 21 | Munson Healthcare Grayling Grayling, MI facility · fee schedule · outpatient | 1 | $23.23 | $23.23 – $23.23 |
| 22 | Munson Healthcare Grayling Grayling, MI professional · fee schedule · both | 1 | $10.17 | $10.17 – $10.17 |
| 23 | Munson Healthcare Manistee Hospital Manistee, MI professional · fee schedule · both | 1 | $10.17 | $10.17 – $10.17 |
| 24 | Munson Healthcare Otsego Memorial Hospital Gaylord, MI professional · fee schedule · both | 1 | $10.17 | $10.17 – $10.17 |
| 25 | Munson Medical Center Traverse City, MI facility · fee schedule · outpatient | 1 | $18.05 | $18.05 – $18.05 |
← Payers reporting HCPCS A0021 · Snapshot 20261108T203506Z-bb90dbab