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
Mirotract matrix sheet
Low
$194
Average
$453
Median
$546
High
$551
Each hospital's average Medica rate, under the methodology and billing class chosen below.
16 hospitals; the 90th percentile is 2.4× 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.
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16 hospital rates
iThe hospitals that file a Medica 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 | Allen Memorial Hospital Corporation Waterloo, IA percent of total billed charges · outpatientfrom % of charges | 1 | $229 | $243 | $67 | 27% | — | $149 – $353 |
| 2 | Altru Hospital Grand Forks, ND facility · fee schedule · outpatient | 4 | $246 | $295 | $139 | 47% | — | $175 – $515 |
| 3 | Altru Hospital Devils Lake Devils Lake, ND facility · fee schedule · outpatient | 4 | $246 | $295 | $139 | 47% | — | $175 – $515 |
| 4 | Fairview Bethesda Hospital St. Paul, MN fee schedule · both | 2 | $551 | $551 | $5 | 1% | — | $546 – $556 |
| 5 | Fairview Health Services Edina, MN fee schedule · both | 2 | $551 | $551 | $5 | 1% | — | $546 – $556 |
| 6 | Fairview Health Services Minneapolis, MN fee schedule · both | 2 | $551 | $551 | $5 | 1% | — | $546 – $556 |
| 7 | Fairview Health Services Burnsville, MN fee schedule · both | 2 | $551 | $551 | $5 | 1% | — | $546 – $556 |
| 8 | Fairview Health Services Wyoming, MN fee schedule · both | 2 | $551 | $551 | $5 | 1% | — | $546 – $556 |
| 9 | Fairview Health Services Princeton, MN fee schedule · both | 2 | $551 | $551 | $5 | 1% | — | $546 – $556 |
| 10 | Fairview Maple Grove Surgery Center Maple Grove, MN fee schedule · both | 4 | $546 | $546 | — | — | — | $546 – $546 |
| 11 | GILLETTE CHILDREN'S SPECIALTY HEALTHCARE PAUL, MN professional · fee schedule · outpatient | 1 | $530 | $530 | — | — | — | $530 – $530 |
| 12 | HealthEast St John's Hospital Maplewood, MN fee schedule · both | 2 | $551 | $551 | $5 | 1% | — | $546 – $556 |
| 13 | HealthEast Woodwinds Hospital Woodbury, MN fee schedule · both | 2 | $546 | $546 | — | — | — | $546 – $546 |
| 14 | Range Regional Health Services Hibbing, MN professional · fee schedule · both | 1 | $515 | $515 | — | — | — | $515 – $515 |
| 15 | UnityPoint Health Marshalltown Marshalltown, IA percent of total billed charges · outpatientfrom % of charges | 1 | $208 | $221 | $61 | 28% | — | $136 – $322 |
| 16 | Valley County Hospital NE 68862-1240; 400 S 23rd St Ord, NE professional · fee schedule · both | 3 | $226 | $194 | $54 | 28% | — | $117 – $238 |
← Payers reporting HCPCS A2029 · Snapshot 20261112T181611Z-3fa9fb76