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
$2
Average
$31
Median
$15
High
$125
Each hospital's average Aetna rate, under the methodology and billing class chosen below.
23 hospitals; the 90th percentile is 20.3× 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.
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30 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 | Burgess Health Center Onawa, IA facility · per diem · inpatient | 1 | $44 | $90 | $66 | 73% | — | $44 – $184 |
| 2 | Burgess Health Center Onawa, IA facility · percent of total billed charges · outpatientfrom % of charges | 1 | $22 | $46 | $34 | 73% | — | $22 – $94 |
| 3 | Cheshire Medical Center Keene, NH professional · fee schedule · outpatient | 1 | $4 | $4 | — | — | — | $4 – $4 |
| 4 | Clifton Springs Hospital And Clinic Clifton Springs, NY facility · fee schedule · outpatient | 1 | $9 | $9 | — | — | — | $9 – $9 |
| 5 | Columbia Lutheran Charities Astoria, OR facility · percent of total billed charges · bothfrom % of charges | 2 | $53 | $53 | $23 | 44% | — | $29 – $76 |
| 6 | Covenant Medical Center Lubbock, TX fee schedule · outpatient | 1 | $48 | $48 | — | — | — | $48 – $48 |
| 7 | Covenant Medical Center Inc Saginaw, MI professional · fee schedule · both | 1 | $9 | $9 | — | — | — | $9 – $9 |
| 8 | Covenant Medical Center Inc Saginaw, MI professional · fee schedule · both | 1 | $9 | $9 | — | — | — | $9 – $9 |
| 9 | EATON RAPIDS MEDICAL CENTER Eaton Rapids, MI percent of total billed charges · outpatientfrom % of charges | 1 | $30 | $30 | — | — | — | $30 – $30 |
| 10 | HCA FLORIDA LARGO WEST HOSPITAL LARGO, FL percent of total billed charges · outpatientfrom % of charges | 2 | $6 | $13 | $10 | 80% | — | $1 – $27 |
| 11 | HERITAGE VALLEY BEAVER BEAVER, PA percent of total billed charges · bothfrom % of charges | 1 | $12 | $11 | $3 | 30% | — | $7 – $15 |
| 12 | HERITAGE VALLEY SEWICKLEY SEWICKLEY, PA percent of total billed charges · bothfrom % of charges | 1 | $12 | $11 | $3 | 30% | — | $7 – $15 |
| 13 | Lubbock Heritage Hospital LLC Lubbock, TX fee schedule · outpatient | 1 | $48 | $48 | — | — | — | $48 – $48 |
| 14 | MEMORIAL HEALTH SYSTEM OF EAST TEXAS Lufkin, TX fee schedule · inpatient | 1 | $39 | $39 | — | — | — | $39 – $39 |
| 15 | MEMORIAL HEALTH SYSTEM OF EAST TEXAS Lufkin, TX fee schedule · outpatient | 1 | $39 | $39 | — | — | — | $39 – $39 |
| 16 | MEMORIAL HOSPITAL OF POLK COUNTY Livingston, TX fee schedule · inpatient | 1 | $38 | $38 | — | — | — | $38 – $38 |
| 17 | MEMORIAL HOSPITAL OF POLK COUNTY Livingston, TX fee schedule · outpatient | 1 | $38 | $38 | — | — | — | $38 – $38 |
| 18 | MEMORIAL MEDICAL CENTER SAN AUGUSTINE San Augustine, TX fee schedule · inpatient | 1 | $15 | $15 | — | — | — | $15 – $15 |
| 19 | MEMORIAL MEDICAL CENTER SAN AUGUSTINE San Augustine, TX fee schedule · outpatient | 1 | $15 | $15 | — | — | — | $15 – $15 |
| 20 | Mary Hitchcock Memorial Hospital Lebanon, NH professional · fee schedule · outpatient | 3 | $47 | $47 | — | — | — | $47 – $47 |
| 21 | Memorial Hospital of Laramie County Cheyenne, WY percent of total billed charges · bothfrom % of charges | 1 | $6 | $6 | — | — | — | $6 – $6 |
| 22 | STATE OF MISSISSIPPI-UNIVERSITY OF MISSISSIPPI MEDICAL CENTER JACKSON, MS percent of total billed charges · bothfrom % of charges | 1 | $41 | $41 | $11 | 27% | — | $30 – $52 |
| 23 | SwedishAmerican Hospital IL 61104; 1625 S State St Belvidere, IL percent of total billed charges · bothfrom % of charges | 1 | $117 | $117 | — | — | — | $117 – $117 |
| 24 | SwedishAmerican Hospital IL 61104; 1625 S State St Belvidere, IL percent of total billed charges · outpatientfrom % of charges | 1 | $48 | $48 | — | — | — | $48 – $48 |
| 25 | UPMC Magee-Womens Hospital Pittsburgh, PA facility · percent of total billed charges · inpatientfrom % of charges | 5 | $3 | $3 | $0 | 4% | — | $3 – $3 |
← Payers reporting HCPCS J2275 · Snapshot 20261113T090226Z-3ce6c0b8