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
$143
Median
$155
High
$469
Each hospital's average Aetna rate, under the methodology and billing class chosen below.
16 hospitals; the 90th percentile is 2.9× 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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17 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 | COMMUNITY MEMORIAL HOSPITAL Hill, VA case rate · outpatient | 1 | $178 | $178 | — | — | — | $178 – $178 |
| 2 | Conway Hospital, Inc. Conway, SC professional · fee schedule · outpatient | 1 | $48 | $48 | — | — | — | $48 – $48 |
| 3 | Covenant Medical Center Inc Saginaw, MI professional · fee schedule · both | 1 | $84 | $84 | — | — | — | $84 – $84 |
| 4 | Covenant Medical Center Inc Saginaw, MI professional · fee schedule · both | 1 | $84 | $84 | — | — | — | $84 – $84 |
| 5 | Doctors’ Hospital of Williamsburg Williamsburg, VA fee schedule · outpatient | 1 | $167 | $167 | — | — | — | $167 – $167 |
| 6 | Loyola University Medical Center Maywood, IL facility · case rate · outpatient | 1 | $168 | $168 | — | — | — | $168 – $168 |
| 7 | MacNeal Hospital Berwyn, IL facility · case rate · outpatient | 1 | $116 | $116 | — | — | — | $116 – $116 |
| 8 | Mary Hitchcock Memorial Hospital Lebanon, NH professional · fee schedule · outpatient | 3 | $78 | $78 | — | — | — | $78 – $78 |
| 9 | Oklahoma State University Medical Center Tulsa, OK facility · fee schedule · outpatient | 1 | $74 | $74 | — | — | — | $74 – $74 |
| 10 | Riverside Hospital Inc Newport News, VA fee schedule · outpatient | 1 | $155 | $155 | — | — | — | $155 – $155 |
| 11 | Riverside Middle Peninsula Hospital, Inc Gloucester, VA fee schedule · outpatient | 1 | $167 | $167 | — | — | — | $167 – $167 |
| 12 | SHORE HEALTH SERVICES INC. Onancock, VA fee schedule · outpatient | 1 | $155 | $155 | — | — | — | $155 – $155 |
| 13 | UPMC Magee-Womens Hospital Pittsburgh, PA facility · percent of total billed charges · inpatientfrom % of charges | 5 | $469 | $465 | $18 | 4% | — | $431 – $478 |
| 14 | UPMC Magee-Womens Hospital Pittsburgh, PA facility · percent of total billed charges · outpatientfrom % of charges | 7 | $478 | $473 | $150 | 32% | — | $215 – $634 |
| 15 | UPMC Passavant - McCandless Cranberry Township, PA facility · percent of total billed charges · outpatientfrom % of charges | 1 | $1 | $1 | — | — | — | $1 – $1 |
| 16 | VCU HEALTH TAPPAHANNOCK HOSPITAL Tappahannock, VA case rate · outpatient | 1 | $173 | $173 | — | — | — | $173 – $173 |
| 17 | VIRGINIA COMMONWEALTH UNIVERSITY HEALTH SYSTEM AUTHORITY Richmond, VA case rate · outpatient | 1 | $174 | $174 | — | — | — | $174 – $174 |
← Payers reporting HCPCS J9199 · Snapshot 20261113T090226Z-3ce6c0b8