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
Sewho cap design w/jnt(s) cf
The hospitals that file a Ambetter 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.
Filter by billing methodology
Filter by billing class
84 hospital rates
| # | Plans | |||
|---|---|---|---|---|
| 1 | Advocate Childrens Hospital Oak Lawn Oak Lawn, IL facility · case rate · outpatient | 1 | $2,994 | $2,994 – $2,994 |
| 2 | Advocate Childrens Hospital Park Ridge Park Ridge, IL facility · case rate · outpatient | 1 | $2,994 | $2,994 – $2,994 |
| 3 | Advocate Christ Medical Center Oak Lawn, IL facility · case rate · outpatient | 1 | $2,994 | $2,994 – $2,994 |
| 4 | Advocate Condell Medical Center Libertyville, IL case rate · outpatient | 1 | $2,994 | $2,994 – $2,994 |
| 5 | Advocate Good Samaritan Hospital Downers Grove, IL case rate · outpatient | 1 | $2,994 | $2,994 – $2,994 |
| 6 | Advocate Good Shepherd Hospital Barrington, IL case rate · outpatient | 1 | $2,994 | $2,994 – $2,994 |
| 7 | Advocate Illinois Masonic Medical Center Chicago, IL case rate · outpatient | 1 | $2,994 | $2,994 – $2,994 |
| 8 | Advocate Lutheran General Hospital Park Ridge, IL case rate · outpatient | 1 | $2,994 | $2,994 – $2,994 |
| 9 | Advocate Sherman Hospital Elgin, IL case rate · outpatient | 1 | $2,994 | $2,994 – $2,994 |
| 10 | Advocate South Suburban Hospital Hazel Crest, IL case rate · outpatient | 1 | $2,994 | $2,994 – $2,994 |
| 11 | Advocate Trinity Hospital Chicago, IL case rate · outpatient | 1 | $2,994 | $2,994 – $2,994 |
| 12 | Bartow Regional Medical Center Bartow, FL facility · fee schedule · outpatient | 2 | $4,671 | $4,671 – $4,671 |
| 13 | Baycare Hospital Wesley Chapel Chapel, FL facility · fee schedule · outpatient | 2 | $4,982 | $4,671 – $5,293 |
| 14 | Bayhealth Hospital, Sussex Campus Milton, DE fee schedule · outpatient | 1 | $3,083 | $3,083 – $3,083 |
| 15 | Bayhealth Medical Center, Kent Campus Dover, DE fee schedule · outpatient | 1 | $3,083 | $3,083 – $3,083 |
| 16 | Beaufort Memorial Hospital Beaufort, SC facility · fee schedule · outpatient | 1 | $5,024 | $5,024 – $5,024 |
| 17 | Cheshire Medical Center Keene, NH facility · fee schedule · outpatient | 1 | $2,015 | $2,015 – $2,015 |
| 18 | Cheshire Medical Center Keene, NH professional · fee schedule · outpatient | 1 | $1,679 | $1,679 – $1,679 |
| 19 | Floyd Healthcare Management Inc Rome, GA case rate · outpatient | 1 | $3,114 | $3,114 – $3,114 |
| 20 | Good Samaritan Hospital Puyallup, WA fee schedule · outpatient | 1 | $4,029 | $4,029 – $4,029 |
| 21 | Grady Memorial Hospital Atlanta, GA facility · fee schedule · outpatient | 1 | $2,076 | $2,076 – $2,076 |
| 22 | Hendrick Medical Center Brownwood, TX facility · case rate · outpatient | 1 | $5,694 | $5,694 – $5,694 |
| 23 | HonorHealth Florence Medical Center Florence, AZ facility · fee schedule · outpatient | 1 | $2,919 | $2,919 – $2,919 |
| 24 | Honorhealth Deer Valley Medical Center Phoenix, AZ facility · fee schedule · outpatient | 1 | $2,919 | $2,919 – $2,919 |
| 25 | Honorhealth Four Peaks Medical Center Mesa, AZ facility · fee schedule · outpatient | 1 | $2,919 | $2,919 – $2,919 |
← Payers reporting HCPCS L3971 · Snapshot 20261108T055240Z-43b7dac7