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
Oral dv nm mouthpc hw remote
Low
$52
Average
$118
Median
$106
High
$686
Each hospital's average Aetna rate, under the methodology and billing class chosen below.
373 hospitals; the 90th percentile is 1.1× 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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380 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 | ALLE-KISKI MEDICAL CENTER NATRONA HEIGHTS, PA fee schedule · outpatient | 2 | $184 | $184 | $77 | 42% | — | $107 – $261 |
| 2 | Acadia Hospital Bangor, ME professional · fee schedule · outpatient | 1 | $71 | $71 | — | — | — | $71 – $71 |
| 3 | Adena Health System Chillicothe, OH facility · fee schedule · outpatient | 1 | $105 | $105 | — | — | — | $105 – $105 |
| 4 | Allen Memorial Hospital Corporation Waterloo, IA case rate · outpatient | 1 | $105 | $105 | — | — | — | $105 – $105 |
| 5 | Alta Newport Hospital, LLC Tustin, CA facility · case rate · outpatient | 4 | $102 | $109 | $14 | 13% | — | $100 – $134 |
| 6 | American Hospital Management Corporation Arcata, CA facility · case rate · outpatient | 1 | $103 | $103 | — | — | — | $103 – $103 |
| 7 | Atrium Health Hospitals Inc Kings Mountain, NC fee schedule · outpatient | 1 | $107 | $107 | — | — | — | $107 – $107 |
| 8 | Atrium Health Hospitals Inc Lincolnton, NC fee schedule · outpatient | 1 | $107 | $107 | — | — | — | $107 – $107 |
| 9 | Atrium Health Hospitals Inc Wadesboro, NC fee schedule · outpatient | 1 | $107 | $107 | — | — | — | $107 – $107 |
| 10 | Berger Hospital Circleville, OH fee schedule · outpatient | 1 | $143 | $143 | — | — | — | $143 – $143 |
| 11 | Bethesda Hospital Inc. Lebanon, OH facility · fee schedule · outpatient | 1 | $154 | $154 | $2 | 1% | — | $153 – $156 |
| 12 | Bexar County Hospital District San Antonio, TX fee schedule · outpatient | 1 | $103 | $103 | — | — | — | $103 – $103 |
| 13 | Blue Hill Memorial Hospital Hill, ME professional · fee schedule · outpatient | 1 | $71 | $71 | — | — | — | $71 – $71 |
| 14 | Boulder Community Health Lafayette, CO facility · case rate · outpatient | 1 | $105 | $105 | — | — | — | $105 – $105 |
| 15 | Boulder Community Health Lafayette, CO professional · fee schedule · both | 2 | $52 | $67 | $21 | 32% | — | $52 – $97 |
| 16 | Broaddus Hospital Association Inc Philippi, WV professional · fee schedule · both | 1 | $81 | $81 | — | — | — | $81 – $81 |
| 17 | Butler Healthcare Providers_ DBA Butler Memorial Hospital Butler, PA facility · fee schedule · outpatient | 1 | $156 | $156 | — | — | — | $156 – $156 |
| 18 | CANONSBURG GENERAL HOSPITAL CANONSBURG, PA fee schedule · outpatient | 2 | $187 | $187 | $80 | 43% | — | $107 – $267 |
| 19 | CAREPARTNERS REHABILITATION HOSPITAL Asheville, NC fee schedule · outpatient | 1 | $107 | $107 | — | — | — | $107 – $107 |
| 20 | CATHOLIC HEALTH INIATIVES COLORADO Westminster, CO fee schedule · outpatient | 1 | $103 | $103 | — | — | — | $103 – $103 |
| 21 | CATHOLIC HEALTH INITIATIVES COLORADO Pueblo, CO fee schedule · outpatient | 1 | $103 | $103 | — | — | — | $103 – $103 |
| 22 | CATHOLIC HEALTH INITIATIVES COLORADO Colorado Springs, CO fee schedule · outpatient | 1 | $103 | $103 | — | — | — | $103 – $103 |
| 23 | CATHOLIC HEALTH INITIATIVES COLORADO West Jordan, UT fee schedule · outpatient | 1 | $105 | $105 | — | — | — | $105 – $105 |
| 24 | CATHOLIC HEALTH INITIATIVES COLORADO Frisco, CO fee schedule · outpatient | 1 | $103 | $103 | — | — | — | $103 – $103 |
| 25 | CATHOLIC HEALTH INITIATIVES COLORADO Durango, CO fee schedule · outpatient | 1 | $103 | $103 | — | — | — | $103 – $103 |
← Payers reporting HCPCS E0491 · Snapshot 20261112T124536Z-e251e855