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 Medicaid 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.
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20 hospital rates
| # | Plans | |||
|---|---|---|---|---|
| 1 | Allina Health Systems Shakopee, MN facility · fee schedule · outpatient | 1 | $2,104 | $2,104 – $2,104 |
| 2 | Allina Health Systems MN; 1175 Nininger Road. Hastings, MN facility · fee schedule · outpatient | 1 | $2,104 | $2,104 – $2,104 |
| 3 | Allina Health Systems Owatonna, MN facility · fee schedule · outpatient | 1 | $2,104 | $2,104 – $2,104 |
| 4 | Allina Health Systems Ulm, MN facility · other · outpatient | 1 | $2,120 | $2,120 – $2,120 |
| 5 | Allina Health Systems MN 55443; 550 Osborne Road NE. Fridley, MN facility · fee schedule · outpatient | 1 | $2,104 | $2,104 – $2,104 |
| 6 | Allina Health Systems Cambridge, MN facility · fee schedule · outpatient | 1 | $2,104 | $2,104 – $2,104 |
| 7 | Allina Health Systems River Falls, WI facility · fee schedule · outpatient | 1 | $2,104 | $2,104 – $2,104 |
| 8 | Allina Health Systems Minneapolis, MN facility · fee schedule · outpatient | 1 | $2,104 | $2,104 – $2,104 |
| 9 | Allina Health Systems Buffalo, MN facility · fee schedule · outpatient | 1 | $2,104 | $2,104 – $2,104 |
| 10 | CATHOLIC HEALTH INITIATIVES COLORADO Salt Lake City, UT fee schedule · outpatient | 1 | $1,774 | $1,774 – $1,774 |
| 11 | FRANCISCAN ALLIANCE, INC. dba FRANCISCAN HEALTH CARMEL CARMEL, IN fee schedule · both | 2 | $2,271 | $2,065 – $2,478 |
| 12 | FRANCISCAN ALLIANCE, INC. dba FRANCISCAN HEALTH CROWN POINT CROWN POINT, IN fee schedule · both | 14 | $2,162 | $2,065 – $2,478 |
| 13 | FRANCISCAN ALLIANCE, INC. dba FRANCISCAN HEALTH DYER DYER, IN fee schedule · both | 14 | $2,168 | $2,065 – $2,478 |
| 14 | FRANCISCAN ALLIANCE, INC. dba FRANCISCAN HEALTH INDIANAPOLIS INDIANAPOLIS, IN fee schedule · both | 16 | $2,156 | $2,065 – $2,478 |
| 15 | FRANCISCAN ALLIANCE, INC. dba FRANCISCAN HEALTH LAFAYETTE LAFAYETTE, IN fee schedule · both | 2 | $2,271 | $2,065 – $2,478 |
| 16 | FRANCISCAN ALLIANCE, INC. dba FRANCISCAN HEALTH MICHIGAN CITY CITY, IN fee schedule · both | 2 | $2,271 | $2,065 – $2,478 |
| 17 | FRANCISCAN ALLIANCE, INC. dba FRANCISCAN HEALTH MICHIGAN CITY LAPORTE PORTE, IN fee schedule · both | 2 | $2,271 | $2,065 – $2,478 |
| 18 | FRANCISCAN ALLIANCE, INC. dba FRANCISCAN HEALTH MOORESVILLE MOORESVILLE, IN fee schedule · both | 2 | $2,271 | $2,065 – $2,478 |
| 19 | FRANCISCAN ALLIANCE, INC. dba FRANCISCAN HEALTH MUNSTER MUNSTER, IN fee schedule · both | 2 | $2,271 | $2,065 – $2,478 |
| 20 | FRANCISCAN HEALTH RENSSELAER, INC. RENSSELAER, IN fee schedule · both | 2 | $2,271 | $2,065 – $2,478 |
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