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
HB-Cica Care Sheet, per Each
Low
$13
Average
$105
Median
$92
High
$251
Each hospital's average Ambetter rate, under the methodology and billing class chosen below.
11 hospitals; the 90th percentile is 19.9× 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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12 hospital rates
iThe hospitals that file a Ambetter 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 | Central Community Hospital Elkader, IA facility · percent of total billed charges · bothfrom % of charges | 1 | $100 | $100 | $7 | 7% | — | $93 – $108 |
| 2 | Mercy Hospital Springfield Ozark, MO facility · percent of total billed charges · outpatientfrom % of charges | 1 | $13 | $13 | — | — | — | $13 – $13 |
| 3 | Mercy Hospital Springfield Springfield, MO facility · percent of total billed charges · outpatientfrom % of charges | 1 | $13 | $13 | — | — | — | $13 – $13 |
| 4 | Mercy Hospital of Franciscan Sisters Inc Oelwein, IA facility · percent of total billed charges · bothfrom % of charges | 1 | $79 | $79 | $6 | 7% | — | $73 – $85 |
| 5 | Mercy Medical Center - Dyersville Dyersville, IA facility · percent of total billed charges · bothfrom % of charges | 1 | $108 | $108 | $8 | 7% | — | $100 – $116 |
| 6 | Mercy Medical Center - New Hampton New Hampton, IA facility · percent of total billed charges · bothfrom % of charges | 1 | $92 | $92 | $7 | 7% | — | $85 – $98 |
| 7 | Pender Memorial Hospital, Incorporated Burgaw, NC fee schedule · outpatient | 1 | $30 | $30 | — | — | — | $30 – $30 |
| 8 | St. Joseph's Mercy Hospital, Centerville Centerville, IA facility · percent of total billed charges · bothfrom % of charges | 1 | $56 | $56 | $4 | 7% | — | $52 – $60 |
| 9 | University Hospitals Health System Geneva, OH facility · percent of total billed charges · outpatientfrom % of charges | 1 | $161 | $161 | $145 | 90% | — | $16 – $307 |
| 10 | University Hospitals Health System Conneaut, OH facility · percent of total billed charges · outpatientfrom % of charges | 1 | $250 | $250 | $225 | 90% | — | $25 – $475 |
| 11 | University Hospitals Health System Cleveland, OH facility · percent of total billed charges · inpatientfrom % of charges | 1 | $251 | $251 | $226 | 90% | — | $25 – $477 |
| 12 | University Hospitals Health System Cleveland, OH facility · percent of total billed charges · outpatientfrom % of charges | 1 | $251 | $251 | $226 | 90% | — | $25 – $477 |
← Payers reporting HCPCS A6025 · Snapshot 20261111T120946Z-9134e7f7