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
$19
Median
$3
High
$107
Each hospital's average Aetna rate, under the methodology and billing class chosen below.
10 hospitals; the 90th percentile is 90.4× 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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11 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 | CHI MEMORIAL HOSPITAL - GEORGIA Ringgold, GA fee schedule · inpatient | 3 | $68 | $68 | — | — | — | $68 – $68 |
| 2 | CHI MEMORIAL HOSPITAL - GEORGIA Ringgold, GA fee schedule · outpatient | 3 | $68 | $68 | — | — | — | $68 – $68 |
| 3 | Cheshire Medical Center Keene, NH professional · fee schedule · outpatient | 1 | $2 | $2 | — | — | — | $2 – $2 |
| 4 | Clifton Springs Hospital And Clinic Clifton Springs, NY facility · fee schedule · outpatient | 1 | $1 | $1 | — | — | — | $1 – $1 |
| 5 | Covenant Medical Center Lubbock, TX fee schedule · outpatient | 1 | $4 | $4 | — | — | — | $4 – $4 |
| 6 | Covenant Medical Center Inc Saginaw, MI professional · fee schedule · both | 1 | $1 | $1 | — | — | — | $1 – $1 |
| 7 | Covenant Medical Center Inc Saginaw, MI professional · fee schedule · both | 1 | $1 | $1 | — | — | — | $1 – $1 |
| 8 | Lubbock Heritage Hospital LLC Lubbock, TX fee schedule · outpatient | 1 | $4 | $4 | — | — | — | $4 – $4 |
| 9 | Mary Hitchcock Memorial Hospital Lebanon, NH professional · fee schedule · outpatient | 3 | $5 | $3 | $2 | 54% | — | $1 – $5 |
| 10 | Memorial Hospital of Laramie County Cheyenne, WY percent of total billed charges · bothfrom % of charges | 1 | $1 | $1 | — | — | — | $1 – $1 |
| 11 | Stephens County Hospital Toccoa, GA percent of total billed charges · outpatientfrom % of charges | 1 | $107 | $107 | $20 | 18% | — | $87 – $126 |
← Payers reporting HCPCS J1590 · Snapshot 20261111T120946Z-9134e7f7