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
$3
High
$188
Each hospital's average Aetna rate, under the methodology and billing class chosen below.
9 hospitals; the 90th percentile is 37.3× 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.
Filter by billing methodology
Filter by billing class
9 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 | Cheshire Medical Center Keene, NH professional · fee schedule · outpatient | 1 | $3 | $3 | — | — | — | $3 – $3 |
| 2 | Conway Hospital, Inc. Conway, SC professional · fee schedule · outpatient | 1 | $188 | $188 | — | — | — | $188 – $188 |
| 3 | Covenant Medical Center Lubbock, TX fee schedule · outpatient | 1 | $9 | $9 | — | — | — | $9 – $9 |
| 4 | Covenant Medical Center Inc Saginaw, MI professional · fee schedule · both | 1 | $2 | $2 | — | — | — | $2 – $2 |
| 5 | Covenant Medical Center Inc Saginaw, MI professional · fee schedule · both | 1 | $2 | $2 | — | — | — | $2 – $2 |
| 6 | LUCILE SALTER PACKARD CHILDREN'S HOSPITAL AT STANFORD PALO ALTO, CA percent of total billed charges · outpatientfrom % of charges | 1 | $15 | $15 | — | — | — | $15 – $15 |
| 7 | Lubbock Heritage Hospital LLC Lubbock, TX fee schedule · outpatient | 1 | $9 | $9 | — | — | — | $9 – $9 |
| 8 | Mary Hitchcock Memorial Hospital Lebanon, NH professional · fee schedule · outpatient | 3 | $1 | $1 | — | — | — | $1 – $1 |
| 9 | Memorial Hospital of Laramie County Cheyenne, WY percent of total billed charges · bothfrom % of charges | 1 | $1 | $1 | — | — | — | $1 – $1 |
← Payers reporting HCPCS G9017 · Snapshot 20261113T090226Z-3ce6c0b8