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
$1
Average
$26
Median
$4
High
$763
Each hospital's average Anthem rate, under the methodology and billing class chosen below.
56 hospitals; the 90th percentile is 13.7× 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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57 hospital rates
iThe hospitals that file a Anthem 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 | AKRON GENERAL MEDICAL CENTER Akron, OH facility · case rate · outpatient | 1 | $15 | $15 | — | — | — | $15 – $15 |
| 2 | Acadia Hospital Bangor, ME facility · fee schedule · outpatient | 2 | $3 | $3 | $0 | 13% | — | $3 – $4 |
| 3 | Acadia Hospital Bangor, ME professional · fee schedule · outpatient | 1 | $3 | $3 | — | — | — | $3 – $3 |
| 4 | CLEVELAND CLINIC AVON HOSPITAL Avon, OH facility · case rate · outpatient | 1 | $14 | $14 | — | — | — | $14 – $14 |
| 5 | CLEVELAND CLINIC CHILDREN'S HOSPITAL FOR REHABILITATION Cleveland, OH facility · case rate · outpatient | 1 | $26 | $26 | — | — | — | $26 – $26 |
| 6 | CLEVELAND CLINIC HEALTH SYSTEM - EAST REGION Mentor, OH facility · case rate · outpatient | 1 | $16 | $16 | — | — | — | $16 – $16 |
| 7 | CLEVELAND CLINIC HEALTH SYSTEM - EAST REGION Euclid, OH facility · case rate · outpatient | 1 | $16 | $16 | — | — | — | $16 – $16 |
| 8 | CLEVELAND CLINIC HEALTH SYSTEM - EAST REGION Warrensville Heights, OH facility · case rate · outpatient | 1 | $17 | $17 | — | — | — | $17 – $17 |
| 9 | Cheshire Medical Center Keene, NH professional · fee schedule · outpatient | 1 | $5 | $5 | — | — | — | $5 – $5 |
| 10 | Cleveland Clinic Mercy Hospital Canton, OH facility · case rate · outpatient | 1 | $15 | $15 | — | — | — | $15 – $15 |
| 11 | Diley Ridge Medical Center Canal Winchester, OH facility · percent of total billed charges · bothfrom % of charges | 1 | $4 | $4 | — | — | — | $4 – $4 |
| 12 | Fairview Hospital Cleveland, OH facility · case rate · outpatient | 1 | $15 | $15 | — | — | — | $15 – $15 |
| 13 | Fisher-Titus Medical Center Norwalk, OH facility · case rate · outpatient | 1 | $10 | $10 | — | — | — | $10 – $10 |
| 14 | Holy Cross Germantown Hospital Germantown, MD facility · percent of total billed charges · bothfrom % of charges | 1 | $3 | $3 | — | — | — | $3 – $3 |
| 15 | Holy Cross Hospital-Ft. Lauderdale Ft. Lauderdale, FL facility · per diem · both | 1 | $763 | $763 | — | — | — | $763 – $763 |
| 16 | Holy Cross Hospital-Silver Spring Silver Spring, MD facility · percent of total billed charges · bothfrom % of charges | 1 | $2 | $2 | — | — | — | $2 – $2 |
| 17 | Johnson Memorial Hospital Stafford Springs, CT facility · percent of total billed charges · bothfrom % of charges | 3 | $2 | $2 | $0 | 6% | — | $2 – $2 |
| 18 | LODI COMMUNITY HOSPITAL Lodi, OH facility · case rate · outpatient | 1 | $25 | $25 | — | — | — | $25 – $25 |
| 19 | LUTHERAN HOSPITAL Cleveland, OH facility · case rate · outpatient | 1 | $15 | $15 | — | — | — | $15 – $15 |
| 20 | Little Company of Mary Hospital of Indiana Inc Jasper, IN professional · fee schedule · both | 1 | $3 | $3 | — | — | — | $3 – $3 |
| 21 | MARYMOUNT HOSPITAL INC Garfield Heights, OH facility · case rate · outpatient | 1 | $14 | $14 | — | — | — | $14 – $14 |
| 22 | MEDINA HOSPITAL Medina, OH facility · case rate · outpatient | 1 | $15 | $15 | — | — | — | $15 – $15 |
| 23 | Mary Hitchcock Memorial Hospital Lebanon, NH professional · fee schedule · outpatient | 11 | $3 | $2 | $1 | 50% | — | $0 – $3 |
| 24 | Mercy Fitzgerald Hospital Darby, PA facility · percent of total billed charges · bothfrom % of charges | 1 | $6 | $6 | — | — | — | $6 – $6 |
| 25 | Mercy Health Hackley Campus Muskogen, MI facility · percent of total billed charges · bothfrom % of charges | 1 | $1 | $1 | — | — | — | $1 – $1 |
← Payers reporting HCPCS A4397 · Snapshot 20261112T124536Z-e251e855