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
$0
Average
$56
Median
$34
High
$284
Each hospital's average Blue Cross Blue Shield rate, under the methodology and billing class chosen below.
22 hospitals; the 90th percentile is 4.6× 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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22 hospital rates
iThe hospitals that file a Blue Cross Blue Shield 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 | Benson Hospital Corporation Benson, AZ facility · fee schedule · outpatient | 1 | $284 | $284 | — | — | — | $284 – $284 |
| 2 | Covenant Medical Center Lubbock, TX fee schedule · outpatient | 4 | $25 | $26 | $0 | 2% | — | $25 – $26 |
| 3 | Edward Hospital Plainfield, IL fee schedule · outpatient | 1 | $64 | $64 | — | — | — | $64 – $64 |
| 4 | Elmhurst Memorial Hospital Elmhurst, IL fee schedule · outpatient | 1 | $64 | $64 | — | — | — | $64 – $64 |
| 5 | Endeavor Health Clinical Operations Skokie, IL fee schedule · outpatient | 3 | $102 | $102 | $7 | 7% | — | $94 – $110 |
| 6 | Essentia Health St. Joseph's Medical Center Brainerd, MN facility · fee schedule · outpatient | 1 | $34 | $34 | — | — | — | $34 – $34 |
| 7 | Essentia Health St. Mary's - Detroit Lakes 1027 Washington Ave. Detroit Lakes, MN facility · fee schedule · outpatient | 2 | $34 | $34 | — | — | — | $34 – $34 |
| 8 | Essentia Health St. Mary's Children's Hospital Duluth, MN facility · fee schedule · outpatient | 1 | $34 | $34 | — | — | — | $34 – $34 |
| 9 | Essentia Health St. Mary's Medical Center Duluth, MN facility · fee schedule · outpatient | 1 | $34 | $34 | — | — | — | $34 – $34 |
| 10 | Lubbock Heritage Hospital LLC Lubbock, TX fee schedule · outpatient | 4 | $25 | $26 | $0 | 2% | — | $25 – $26 |
| 11 | Methodist Children's Hospital Lubbock, TX fee schedule · outpatient | 4 | $25 | $26 | $0 | 2% | — | $25 – $26 |
| 12 | Methodist Hospital Levelland Levelland, TX fee schedule · outpatient | 4 | $24 | $25 | $1 | 2% | — | $24 – $26 |
| 13 | Methodist Hospital Plainview Plainview, TX fee schedule · outpatient | 4 | $24 | $25 | $0 | 2% | — | $24 – $25 |
| 14 | Northwest Community Hospital Arlington Heights, IL fee schedule · outpatient | 2 | $41 | $41 | $3 | 6% | — | $38 – $44 |
| 15 | RAPIDES REGIONAL MEDICAL CENTER ALEXANDRIA, LA fee schedule · outpatient | 2 | $0 | $0 | — | — | — | $0 – $0 |
| 16 | SID Peterson Memorial Hospital Kerrville, TX facility · fee schedule · outpatient | 4 | $22 | $22 | — | — | — | $22 – $22 |
| 17 | St Joseph Regional Medical Center Lewiston, ID fee schedule · outpatient | 1 | $38 | $38 | — | — | — | $38 – $38 |
| 18 | Swedish Covenant Health Chicago, IL fee schedule · outpatient | 2 | $55 | $55 | $3 | 5% | — | $52 – $58 |
| 19 | The University of Texas Southwestern Medical Center at Dallas Dallas, TX fee schedule · both | 1 | $2 | $2 | — | — | — | $2 – $2 |
| 20 | Trinity Medical Center Rock Island, IL case rate · outpatient | 2 | $86 | $86 | — | — | — | $86 – $86 |
| 21 | Tucson Medical Center Tucson, AZ facility · fee schedule · outpatient | 1 | $102 | $102 | — | — | — | $102 – $102 |
| 22 | Tucson Medical Center Tucson, AZ facility · fee schedule · outpatient | 1 | $102 | $102 | — | — | — | $102 – $102 |
← Payers reporting HCPCS K1017 · Snapshot 20261112T181611Z-3fa9fb76