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
Adju cgm supply allowance
Low
$138
Average
$310
Median
$283
High
$1.7k
Each hospital's average Aetna rate, under the methodology and billing class chosen below.
268 hospitals; the 90th percentile is 1.4× 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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269 hospital rates
iThe 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.| # | Plans | |||||||
|---|---|---|---|---|---|---|---|---|
| 1 | ALLE-KISKI MEDICAL CENTER NATRONA HEIGHTS, PA fee schedule · outpatient | 2 | $490 | $490 | $204 | 42% | — | $286 – $695 |
| 2 | Abington Memorial Hospital Abington, PA facility · fee schedule · outpatient | 1 | $279 | $279 | — | — | — | $279 – $279 |
| 3 | Acadia Hospital Bangor, ME professional · fee schedule · outpatient | 1 | $182 | $182 | — | — | — | $182 – $182 |
| 4 | Alta Newport Hospital, LLC Tustin, CA facility · case rate · outpatient | 2 | $355 | $355 | $0 | 0% | — | $355 – $355 |
| 5 | Berger Hospital Circleville, OH fee schedule · outpatient | 1 | $342 | $342 | — | — | — | $342 – $342 |
| 6 | Bethesda Hospital Inc. Lebanon, OH facility · fee schedule · outpatient | 1 | $449 | $449 | $4 | 1% | — | $445 – $454 |
| 7 | Blue Hill Memorial Hospital Hill, ME professional · fee schedule · outpatient | 1 | $182 | $182 | — | — | — | $182 – $182 |
| 8 | Boulder Community Health Lafayette, CO professional · fee schedule · both | 2 | $120 | $156 | $50 | 32% | — | $120 – $226 |
| 9 | Broaddus Hospital Association Inc Philippi, WV professional · fee schedule · both | 1 | $198 | $198 | — | — | — | $198 – $198 |
| 10 | Butler Healthcare Providers_ DBA Butler Memorial Hospital Butler, PA facility · fee schedule · outpatient | 1 | $587 | $587 | — | — | — | $587 – $587 |
| 11 | CANONSBURG GENERAL HOSPITAL CANONSBURG, PA fee schedule · outpatient | 2 | $498 | $498 | $212 | 43% | — | $286 – $710 |
| 12 | CAREPARTNERS REHABILITATION HOSPITAL Asheville, NC fee schedule · outpatient | 1 | $286 | $286 | — | — | — | $286 – $286 |
| 13 | CATHOLIC MEDICAL CENTER MANCHESTER, NH fee schedule · outpatient | 1 | $281 | $281 | — | — | — | $281 – $281 |
| 14 | CENTENNIAL HOSPITAL A CAMPUS OF TMCA ENGLEWOOD, CO fee schedule · outpatient | 2 | $281 | $281 | — | — | — | $281 – $281 |
| 15 | CHIPPENHAM HOSPITAL RICHMOND, VA fee schedule · outpatient | 1 | $284 | $284 | — | — | — | $284 – $284 |
| 16 | CHRISTUS Good Shepherd Hospital - Northpark Longview, TX fee schedule · outpatient | 1 | $275 | $275 | — | — | — | $275 – $275 |
| 17 | CHRISTUS Health - Pine Street Texarkana, TX fee schedule · outpatient | 1 | $275 | $275 | — | — | — | $275 – $275 |
| 18 | CHRISTUS Hospital - Orange Orange, TX fee schedule · outpatient | 1 | $275 | $275 | — | — | — | $275 – $275 |
| 19 | CHRISTUS West Beaumont Beaumont, TX fee schedule · outpatient | 1 | $275 | $275 | — | — | — | $275 – $275 |
| 20 | COLUMBIA MEMORIAL HOSPITAL Hudson, NY facility · fee schedule · outpatient | 1 | $283 | $283 | — | — | — | $283 – $283 |
| 21 | Canton-Potsdam Hospital Potsdam, NY facility · fee schedule · outpatient | 1 | $281 | $281 | — | — | — | $281 – $281 |
| 22 | Central Louisiana Surgical Hospital Alexandria, LA fee schedule · outpatient | 3 | $650 | $562 | $208 | 37% | — | $275 – $762 |
| 23 | Charles A. Dean Memorial Hospital Greenville, ME professional · fee schedule · outpatient | 1 | $182 | $182 | — | — | — | $182 – $182 |
| 24 | Cheshire Medical Center Keene, NH professional · fee schedule · outpatient | 1 | $283 | $283 | — | — | — | $283 – $283 |
| 25 | Christus Health Southeast Texas Beaumont, TX fee schedule · outpatient | 1 | $275 | $275 | — | — | — | $275 – $275 |
← Payers reporting HCPCS A4238 · Snapshot 20261111T120946Z-9134e7f7