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
Fee Schedule
Low
$0
Average
$5
Median
$2
High
$56
Each hospital's average Aetna rate, under the methodology and billing class chosen below.
55 hospitals; the 90th percentile is 7.2× 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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55 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 | Catholic Health Initiatives-Iowa Corp Des Moines, IA facility · percent of total billed charges · bothfrom % of charges | 1 | $0 | $0 | — | — | — | $0 – $0 |
| 2 | Catholic Health Initiatives-Iowa Corp West Des Moines, IA facility · percent of total billed charges · bothfrom % of charges | 1 | $0 | $0 | — | — | — | $0 – $0 |
| 3 | Central Community Hospital Elkader, IA facility · percent of total billed charges · bothfrom % of charges | 2 | $1 | $1 | $0 | 15% | — | $1 – $1 |
| 4 | Cheshire Medical Center Keene, NH professional · fee schedule · outpatient | 1 | $6 | $6 | $0 | 0% | — | $6 – $6 |
| 5 | Covenant Medical Center Lubbock, TX fee schedule · outpatient | 1 | $27 | $27 | — | — | — | $27 – $27 |
| 6 | Covenant Medical Center Inc Waterloo, IA facility · percent of total billed charges · bothfrom % of charges | 1 | $1 | $1 | — | — | — | $1 – $1 |
| 7 | Covenant Medical Center Inc Saginaw, MI professional · fee schedule · both | 1 | $4 | $4 | — | — | — | $4 – $4 |
| 8 | Covenant Medical Center Inc Saginaw, MI professional · fee schedule · both | 1 | $4 | $4 | — | — | — | $4 – $4 |
| 9 | Diley Ridge Medical Center Canal Winchester, OH facility · percent of total billed charges · bothfrom % of charges | 4 | $2 | $2 | $1 | 32% | — | $2 – $4 |
| 10 | Holy Cross Germantown Hospital Germantown, MD facility · percent of total billed charges · bothfrom % of charges | 3 | $3 | $3 | $0 | 4% | — | $3 – $3 |
| 11 | Holy Cross Hospital-Ft. Lauderdale Ft. Lauderdale, FL facility · percent of total billed charges · bothfrom % of charges | 3 | $1 | $1 | $0 | 14% | — | $1 – $1 |
| 12 | Holy Cross Hospital-Silver Spring Silver Spring, MD facility · percent of total billed charges · bothfrom % of charges | 3 | $2 | $2 | $0 | 4% | — | $2 – $2 |
| 13 | Johnson Memorial Hospital Stafford Springs, CT facility · percent of total billed charges · bothfrom % of charges | 2 | $1 | $1 | $0 | 11% | — | $1 – $2 |
| 14 | Lake Charles Memorial Hospital Charles., LA percent of total billed charges · outpatientfrom % of charges | 2 | $21 | $23 | $21 | 91% | — | $2 – $45 |
| 15 | Lubbock Heritage Hospital LLC Lubbock, TX fee schedule · outpatient | 1 | $27 | $27 | — | — | — | $27 – $27 |
| 16 | Mary Hitchcock Memorial Hospital Lebanon, NH professional · fee schedule · outpatient | 3 | $4 | $4 | — | — | — | $4 – $4 |
| 17 | Memorial Hospital of Laramie County Cheyenne, WY percent of total billed charges · bothfrom % of charges | 1 | $6 | $6 | — | — | — | $6 – $6 |
| 18 | Mercy Fitzgerald Hospital Darby, PA facility · percent of total billed charges · bothfrom % of charges | 2 | $3 | $3 | $1 | 29% | — | $2 – $3 |
| 19 | Mercy Health Hackley Campus Muskogen, MI facility · percent of total billed charges · bothfrom % of charges | 2 | $2 | $2 | $0 | 24% | — | $1 – $2 |
| 20 | Mercy Health Lakeshore Campus Shelby, MI facility · percent of total billed charges · bothfrom % of charges | 2 | $2 | $2 | $1 | 52% | — | $1 – $2 |
| 21 | Mercy Health Saint Marys Rockford, MI facility · percent of total billed charges · bothfrom % of charges | 2 | $2 | $2 | $0 | 17% | — | $2 – $3 |
| 22 | Mercy Health Services-Iowa Corp. Mason City, IA facility · percent of total billed charges · bothfrom % of charges | 1 | $1 | $1 | — | — | — | $1 – $1 |
| 23 | Mercy Hospital of Franciscan Sisters Inc Oelwein, IA facility · percent of total billed charges · bothfrom % of charges | 2 | $1 | $1 | $0 | 23% | — | $0 – $1 |
| 24 | Mercy Medical Center - Dubuque Dubuque, IA facility · percent of total billed charges · bothfrom % of charges | 1 | $1 | $1 | — | — | — | $1 – $1 |
| 25 | Mercy Medical Center - Dyersville Dyersville, IA facility · percent of total billed charges · bothfrom % of charges | 1 | $1 | $1 | — | — | — | $1 – $1 |
← Payers reporting HCPCS A4397 · Snapshot 20261112T124536Z-e251e855