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 MultiPlan 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
57 hospital rates
| # | Plans | |||
|---|---|---|---|---|
| 1 | Bexar County Hospital District San Antonio, TX fee schedule · outpatient | 1 | $2,076 | $2,076 – $2,076 |
| 2 | Boulder Community Health Lafayette, CO professional · fee schedule · both | 1 | $3,277 | $3,277 – $3,277 |
| 3 | Childrens Hospital Colorado Aurora, CO percent of total billed charges · inpatientfrom % of charges | 1 | $1,456 | $1,456 – $1,456 |
| 4 | Childrens Hospital Colorado Aurora, CO percent of total billed charges · outpatientfrom % of charges | 1 | $1,456 | $1,456 – $1,456 |
| 5 | Good Samaritan Hospital Puyallup, WA percent of total billed charges · inpatientfrom % of charges | 1 | $1,913 | $1,913 – $1,913 |
| 6 | Good Samaritan Hospital Puyallup, WA percent of total billed charges · outpatientfrom % of charges | 1 | $1,913 | $1,913 – $1,913 |
| 7 | HMH HOSPITALS CORPORATION North Bergen, NJ facility · fee schedule · outpatient | 1 | $5,135 | $5,135 – $5,135 |
| 8 | HealthAlliance Hospital Kingston, NY facility · percent of total billed charges · inpatientfrom % of charges | 1 | $492.00 | $492.00 – $492.00 |
| 9 | HealthAlliance Hospital Kingston, NY facility · percent of total billed charges · outpatientfrom % of charges | 1 | $492.00 | $492.00 – $492.00 |
| 10 | Hendrick Medical Center Abilene, TX facility · percent of total billed charges · inpatientfrom % of charges | 1 | $10,281 | $10,281 – $10,281 |
| 11 | Hendrick Medical Center Abilene, TX facility · percent of total billed charges · outpatientfrom % of charges | 1 | $10,281 | $10,281 – $10,281 |
| 12 | Hendrick Medical Center Brownwood, TX facility · percent of total billed charges · inpatientfrom % of charges | 1 | $8,776 | $8,776 – $8,776 |
| 13 | Hendrick Medical Center Brownwood, TX facility · percent of total billed charges · outpatientfrom % of charges | 1 | $8,776 | $8,776 – $8,776 |
| 14 | Hendrick Medical Center Abilene, TX facility · percent of total billed charges · inpatientfrom % of charges | 1 | $10,281 | $10,281 – $10,281 |
| 15 | Hendrick Medical Center Abilene, TX facility · percent of total billed charges · outpatientfrom % of charges | 1 | $10,281 | $10,281 – $10,281 |
| 16 | Indiana University Health Arnett Inc. Lafayette, IN percent of total billed charges · outpatientfrom % of charges | 2 | $4,666 | $4,533 – $4,800 |
| 17 | Indiana University Health Ball Memorial Hospital Inc. Muncie, IN percent of total billed charges · outpatientfrom % of charges | 2 | $4,666 | $4,533 – $4,800 |
| 18 | Indiana University Health Bedford Inc. Bedford, IN percent of total billed charges · outpatientfrom % of charges | 2 | $4,666 | $4,533 – $4,800 |
| 19 | Indiana University Health Bloomington Inc. Bloomington, IN percent of total billed charges · outpatientfrom % of charges | 2 | $4,666 | $4,533 – $4,800 |
| 20 | Indiana University Health Frankfort Inc. Frankfort, IN percent of total billed charges · outpatientfrom % of charges | 2 | $4,666 | $4,533 – $4,800 |
| 21 | Indiana University Health Inc. Martinsville, IN percent of total billed charges · outpatientfrom % of charges | 2 | $4,666 | $4,533 – $4,800 |
| 22 | Indiana University Health Jay Inc. Portland, IN percent of total billed charges · outpatientfrom % of charges | 2 | $4,666 | $4,533 – $4,800 |
| 23 | Indiana University Health North Hospital Inc. Carmel, IN percent of total billed charges · outpatientfrom % of charges | 2 | $4,666 | $4,533 – $4,800 |
| 24 | Indiana University Health Paoli Inc. Paoli, IN percent of total billed charges · outpatientfrom % of charges | 2 | $4,666 | $4,533 – $4,800 |
| 25 | Indiana University Health Tipton Hospital Inc. Tipton, IN percent of total billed charges · outpatientfrom % of charges | 2 | $4,666 | $4,533 – $4,800 |
← Payers reporting HCPCS L3971 · Snapshot 20261108T055240Z-43b7dac7