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.
Generation details were not recorded for this description.
Original text from hospital filings
Prosthesis modification
Low
$44
Average
$274
Median
$201
High
$1.3k
Each hospital's average Aetna rate, under the methodology and billing class chosen below.
69 hospitals; the 90th percentile is 5.4× 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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72 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 | AKRON GENERAL MEDICAL CENTER Akron, OH professional · percent of total billed charges · outpatientfrom % of charges | 3 | $400 | $425 | $54 | 13% | — | $375 – $500 |
| 2 | Acadia Hospital Bangor, ME professional · fee schedule · outpatient | 1 | $188 | $188 | — | — | — | $188 – $188 |
| 3 | BELLEVUE MEDICAL CENTER LLC Bellevue, NE fee schedule · outpatient | 1 | $79 | $79 | — | — | — | $79 – $79 |
| 4 | Berger Hospital Circleville, OH fee schedule · outpatient | 1 | $304 | $304 | — | — | — | $304 – $304 |
| 5 | Bethesda Hospital Inc. Lebanon, OH facility · fee schedule · outpatient | 1 | $365 | $365 | $4 | 1% | — | $361 – $368 |
| 6 | Blue Hill Memorial Hospital Hill, ME professional · fee schedule · outpatient | 1 | $188 | $188 | — | — | — | $188 – $188 |
| 7 | Butler Healthcare Providers_ DBA Butler Memorial Hospital Butler, PA facility · fee schedule · outpatient | 1 | $251 | $251 | — | — | — | $251 – $251 |
| 8 | CHRISTUS Good Shepherd Hospital - Northpark Longview, TX fee schedule · outpatient | 1 | $86 | $86 | — | — | — | $86 – $86 |
| 9 | COMMUNITY MEMORIAL HOSPITAL Hill, VA case rate · outpatient | 1 | $395 | $395 | — | — | — | $395 – $395 |
| 10 | Chambers Health Anahuac, TX percent of total billed charges · outpatientfrom % of charges | 1 | $224 | $224 | — | — | — | $224 – $224 |
| 11 | Charles A. Dean Memorial Hospital Greenville, ME professional · fee schedule · outpatient | 1 | $188 | $188 | — | — | — | $188 – $188 |
| 12 | Cheshire Medical Center Keene, NH professional · fee schedule · outpatient | 2 | $239 | $239 | — | — | — | $239 – $239 |
| 13 | Clarion Hospital Clarion, PA facility · fee schedule · outpatient | 1 | $251 | $251 | — | — | — | $251 – $251 |
| 14 | Cleveland Clinic Mercy Hospital Canton, OH professional · percent of total billed charges · outpatientfrom % of charges | 3 | $400 | $425 | $54 | 13% | — | $375 – $500 |
| 15 | Cleveland Clinic Weston Hospital Nonprofit Corporation Weston, FL facility · case rate · outpatient | 1 | $200 | $200 | — | — | — | $200 – $200 |
| 16 | Cleveland Clinic Weston Hospital Nonprofit Corporation Weston, FL facility · fee schedule · outpatient | 1 | $142 | $142 | — | — | — | $142 – $142 |
| 17 | Clinton Memorial Hospital Wilmington, OH fee schedule · outpatient | 1 | $365 | $365 | $4 | 1% | — | $361 – $368 |
| 18 | Conway Hospital, Inc. Conway, SC professional · fee schedule · outpatient | 1 | $95 | $95 | — | — | — | $95 – $95 |
| 19 | Covenant Medical Center Lubbock, TX fee schedule · outpatient | 1 | $1.3k | $1.3k | — | — | — | $1.3k – $1.3k |
| 20 | Doctors’ Hospital of Williamsburg Williamsburg, VA fee schedule · outpatient | 1 | $354 | $354 | — | — | — | $354 – $354 |
| 21 | ERIE COUNTY MEDICAL CENTER CORPORATION Buffalo, NY fee schedule · outpatient | 1 | $86 | $86 | — | — | — | $86 – $86 |
| 22 | East Cooper Medical Center LLC Mt Pleasant, SC fee schedule · outpatient | 1 | $163 | $163 | — | — | — | $163 – $163 |
| 23 | Eastern Maine Medical Center Bangor, ME facility · fee schedule · outpatient | 1 | $192 | $192 | — | — | — | $192 – $192 |
| 24 | Eastern Maine Medical Center Bangor, ME professional · fee schedule · outpatient | 2 | $188 | $188 | — | — | — | $188 – $188 |
| 25 | GRITMAN MEDICAL CENTER INC Moscow, ID professional · fee schedule · outpatient | 3 | $106 | $125 | $27 | 21% | — | $106 – $163 |
← Payers reporting HCPCS D5875 · Snapshot 20261112T124536Z-e251e855