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 Medical Mutual 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
30 hospital rates
| # | Plans | |||
|---|---|---|---|---|
| 1 | ALLE-KISKI MEDICAL CENTER NATRONA HEIGHTS, PA fee schedule · outpatient | 1 | $3,688 | $3,688 – $3,688 |
| 2 | Adena Health System Chillicothe, OH facility · fee schedule · outpatient | 1 | $2,508 | $2,508 – $2,508 |
| 3 | Avita Ontario Hospital Ontario, OH per diem · both | 1 | $3,588 | $3,588 – $3,588 |
| 4 | Avita Ontario Hospital Ontario, OH percent of total billed charges · bothfrom % of charges | 2 | $5,710 | $23.43 – $21,737 |
| 5 | Bethesda Hospital Inc. Lebanon, OH facility · fee schedule · outpatient | 1 | $2,148 | $2,148 – $2,148 |
| 6 | Bucyrus Community Hospital Bucyrus, OH per diem · both | 1 | $3,588 | $3,588 – $3,588 |
| 7 | Bucyrus Community Hospital Bucyrus, OH percent of total billed charges · bothfrom % of charges | 2 | $788.42 | $23.43 – $2,182 |
| 8 | CANONSBURG GENERAL HOSPITAL CANONSBURG, PA fee schedule · outpatient | 1 | $3,688 | $3,688 – $3,688 |
| 9 | Fisher-Titus Medical Center Norwalk, OH facility · fee schedule · outpatient | 1 | $2,065 | $2,065 – $2,065 |
| 10 | GROVE CITY MEDICAL CENTER GROVE CITY, PA fee schedule · outpatient | 1 | $3,688 | $3,688 – $3,688 |
| 11 | Galion Community Hospital S., OH per diem · both | 1 | $4,224 | $4,224 – $4,224 |
| 12 | Galion Community Hospital S., OH percent of total billed charges · bothfrom % of charges | 2 | $2,672 | $57.42 – $4,224 |
| 13 | JEFFERSON REGIONAL MEDICAL CENTER JEFFERSON HILLS, PA fee schedule · outpatient | 1 | $3,688 | $3,688 – $3,688 |
| 14 | McCullough-Hyde Memorial Hospital, Inc. Oxford, OH facility · fee schedule · outpatient | 1 | $2,148 | $2,148 – $2,148 |
| 15 | Metrohealth System Parma, OH facility · fee schedule · outpatient | 2 | $1,338 | $1,146 – $1,529 |
| 16 | SAINT VINCENT HEALTH CENTER ERIE, PA fee schedule · outpatient | 1 | $3,688 | $3,688 – $3,688 |
| 17 | The Good Samaritan Hospital of Cincinnati, OH Cincinnati, OH facility · fee schedule · outpatient | 1 | $2,148 | $2,148 – $2,148 |
| 18 | University Hospitals Health System Chardon, OH facility · fee schedule · outpatient | 1 | $2,106 | $2,106 – $2,106 |
| 19 | University Hospitals Health System Ravenna, OH facility · fee schedule · outpatient | 1 | $2,106 | $2,106 – $2,106 |
| 20 | University Hospitals Health System Chardon, OH facility · fee schedule · outpatient | 1 | $2,106 | $2,106 – $2,106 |
| 21 | University Hospitals Health System Beachwood, OH facility · fee schedule · outpatient | 5 | $3,016 | $2,106 – $3,327 |
| 22 | University Hospitals Health System Concord Township, OH facility · fee schedule · outpatient | 5 | $2,948 | $2,106 – $3,159 |
| 23 | University Hospitals Health System Cleveland, OH facility · fee schedule · outpatient | 1 | $2,106 | $2,106 – $2,106 |
| 24 | University Hospitals Health System Parma, OH facility · fee schedule · outpatient | 1 | $2,106 | $2,106 – $2,106 |
| 25 | University Hospitals Health System Beachwood, OH facility · fee schedule · outpatient | 1 | $2,106 | $2,106 – $2,106 |
← Payers reporting HCPCS L3971 · Snapshot 20261108T055240Z-43b7dac7