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
Remove non-resorb barrier
Low
$43
Average
$836
Median
$175
High
$6.5k
Each hospital's average Aetna rate, under the methodology and billing class chosen below.
59 hospitals; the 90th percentile is 48.9× 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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61 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 | ACADIA GENERAL HOSPITAL, INC 1305 CROWLEY RAYNE HWY case rate · outpatient | 1 | $1.1k | $1.1k | — | — | — | $1.1k – $1.1k |
| 2 | Acadia Hospital Bangor, ME professional · fee schedule · outpatient | 1 | $104 | $104 | — | — | — | $104 – $104 |
| 3 | BRFHH MONROE, LLC Monroe, LA case rate · outpatient | 1 | $2.4k | $2.4k | — | — | — | $2.4k – $2.4k |
| 4 | Berger Hospital Circleville, OH fee schedule · outpatient | 1 | $173 | $173 | — | — | — | $173 – $173 |
| 5 | Bethesda Hospital Inc. Lebanon, OH facility · fee schedule · outpatient | 1 | $175 | $175 | $2 | 1% | — | $173 – $176 |
| 6 | Blue Hill Memorial Hospital Hill, ME professional · fee schedule · outpatient | 1 | $104 | $104 | — | — | — | $104 – $104 |
| 7 | Butler Healthcare Providers_ DBA Butler Memorial Hospital Butler, PA facility · fee schedule · outpatient | 1 | $159 | $159 | — | — | — | $159 – $159 |
| 8 | CHRISTUS Good Shepherd Hospital - Northpark Longview, TX fee schedule · outpatient | 1 | $51 | $51 | — | — | — | $51 – $51 |
| 9 | COMMUNITY MEMORIAL HOSPITAL Hill, VA case rate · outpatient | 1 | $1.4k | $1.4k | — | — | — | $1.4k – $1.4k |
| 10 | Charles A. Dean Memorial Hospital Greenville, ME professional · fee schedule · outpatient | 1 | $104 | $104 | — | — | — | $104 – $104 |
| 11 | Clarion Hospital Clarion, PA facility · fee schedule · outpatient | 1 | $159 | $159 | — | — | — | $159 – $159 |
| 12 | Cleveland Clinic Weston Hospital Nonprofit Corporation Weston, FL facility · case rate · outpatient | 1 | $797 | $797 | — | — | — | $797 – $797 |
| 13 | Cleveland Clinic Weston Hospital Nonprofit Corporation Weston, FL facility · fee schedule · outpatient | 1 | $68 | $68 | — | — | — | $68 – $68 |
| 14 | Clinton Memorial Hospital Wilmington, OH fee schedule · outpatient | 1 | $175 | $175 | $2 | 1% | — | $173 – $176 |
| 15 | Doctors’ Hospital of Williamsburg Williamsburg, VA fee schedule · outpatient | 1 | $1.3k | $1.3k | — | — | — | $1.3k – $1.3k |
| 16 | EAST BATON ROUGE MEDICAL CENTER, LLC Baton Rouge, LA case rate · outpatient | 1 | $6.5k | $6.5k | — | — | — | $6.5k – $6.5k |
| 17 | ERIE COUNTY MEDICAL CENTER CORPORATION Buffalo, NY fee schedule · outpatient | 1 | $49 | $49 | — | — | — | $49 – $49 |
| 18 | East Cooper Medical Center LLC Mt Pleasant, SC fee schedule · outpatient | 1 | $68 | $68 | — | — | — | $68 – $68 |
| 19 | Eastern Maine Medical Center Bangor, ME facility · fee schedule · outpatient | 1 | $106 | $106 | — | — | — | $106 – $106 |
| 20 | Eastern Maine Medical Center Bangor, ME professional · fee schedule · outpatient | 2 | $104 | $104 | — | — | — | $104 – $104 |
| 21 | GRITMAN MEDICAL CENTER INC Moscow, ID professional · fee schedule · outpatient | 3 | $61 | $72 | $15 | 21% | — | $61 – $94 |
| 22 | Good Shepherd Medical Center - Longview Longview, TX fee schedule · outpatient | 1 | $51 | $51 | — | — | — | $51 – $51 |
| 23 | Good Shepherd Medical Center - Marshall Marshall, TX fee schedule · outpatient | 1 | $51 | $51 | — | — | — | $51 – $51 |
| 24 | Hilton Head Medical Center LLC Hilton Head Island, SC fee schedule · outpatient | 1 | $68 | $68 | — | — | — | $68 – $68 |
| 25 | INDIAN RIVER MEMORIAL HOSPITAL INC Vero Beach, FL facility · case rate · outpatient | 1 | $730 | $730 | — | — | — | $730 – $730 |
← Payers reporting HCPCS D4286 · Snapshot 20261112T124536Z-e251e855