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 Cigna 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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32 hospital rates
| # | Plans | |||
|---|---|---|---|---|
| 1 | Allen Memorial Hospital Corporation Waterloo, IA fee schedule · both | 1 | $14.77 | $14.77 – $14.77 |
| 2 | Alomere Health Alexandria, MN facility · fee schedule · outpatient | 1 | $22.09 | $22.09 – $22.09 |
| 3 | Benefis Hospitals Inc Helena, MT fee schedule · outpatient | 1 | $9.99 | $9.99 – $9.99 |
| 4 | Benefis Hospitals Inc Helena, MT percent of total billed charges · bothfrom % of charges | 1 | $18,961 | $18,961 – $18,961 |
| 5 | Benefis Hospitals Inc Helena, MT percent of total billed charges · inpatientfrom % of charges | 1 | $18,961 | $18,961 – $18,961 |
| 6 | Blue Hill Memorial Hospital Hill, ME professional · fee schedule · outpatient | 1 | $5.22 | $5.22 – $5.22 |
| 7 | Central Iowa Hospital Corporation Des Moines, IA fee schedule · both | 1 | $14.77 | $14.77 – $14.77 |
| 8 | Central Iowa Hospital Corporation West Des Moines, IA fee schedule · both | 1 | $14.77 | $14.77 – $14.77 |
| 9 | Charles A. Dean Memorial Hospital Greenville, ME professional · fee schedule · outpatient | 1 | $5.22 | $5.22 – $5.22 |
| 10 | Cheshire Medical Center Keene, NH professional · fee schedule · outpatient | 2 | $5.59 | $5.59 – $5.59 |
| 11 | Eastern Maine Medical Center Bangor, ME professional · fee schedule · outpatient | 1 | $5.22 | $5.22 – $5.22 |
| 12 | Fairview Maple Grove Surgery Center Maple Grove, MN fee schedule · both | 1 | $8.35 | $7.62 – $9.08 |
| 13 | Fairview Maple Grove Surgery Center Maple Grove, MN fee schedule · outpatient | 1 | $17.52 | $15.99 – $19.04 |
| 14 | Grinnell Regional Medical Center Grinnell, IA fee schedule · both | 1 | $14.77 | $14.77 – $14.77 |
| 15 | HOLY ROSARY HEALTHCARE DBA INTERMOUNTAIN HEALTH HOLY ROSARY HOSPITAL CITY, MT professional · fee schedule · outpatient | 4 | $10.19 | $10.19 – $10.19 |
| 16 | Maine Coast Regional Health Facilities Ellsworth, ME professional · fee schedule · outpatient | 1 | $5.22 | $5.22 – $5.22 |
| 17 | Mary Hitchcock Memorial Hospital Lebanon, NH professional · fee schedule · outpatient | 2 | $5.64 | $5.64 – $5.64 |
| 18 | Mayo Regional Hospital Dover Foxcroft, ME professional · fee schedule · outpatient | 1 | $5.22 | $5.22 – $5.22 |
| 19 | Memorial Hospital of Laramie County Cheyenne, WY fee schedule · both | 1 | $5.80 | $5.80 – $5.80 |
| 20 | Mercy Hospital Portland, ME professional · fee schedule · outpatient | 1 | $5.22 | $5.22 – $5.22 |
| 21 | Northwest Iowa Hospital Corporation Sioux City, IA fee schedule · both | 1 | $14.77 | $14.77 – $14.77 |
| 22 | Sebasticook Valley Health Pittsfield, ME professional · fee schedule · outpatient | 1 | $5.22 | $5.22 – $5.22 |
| 23 | St Luke's Methodist Hospital Marion, IA fee schedule · both | 1 | $14.77 | $14.77 – $14.77 |
| 24 | The Aroostook Medical Center Isle, ME professional · fee schedule · outpatient | 1 | $5.22 | $5.22 – $5.22 |
| 25 | The Finley Hospital Dubuque, IA fee schedule · both | 1 | $14.77 | $14.77 – $14.77 |
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