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
Ntiol category 4
Low
$921
Average
$6.9k
Median
$6.9k
High
$24.0k
Each hospital's average Aetna rate, under the methodology and billing class chosen below.
84 hospitals; the 90th percentile is 5.3× 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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86 hospital rates
iThe hospitals that file a Aetna 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 | Adventhealth Ottawa Ottawa, KS fee schedule · outpatient | 1 | $7.3k | $7.3k | — | — | — | $7.3k – $7.3k |
| 2 | Adventhealth Shawnee Mission Lenexa, KS fee schedule · outpatient | 1 | $7.3k | $7.3k | — | — | — | $7.3k – $7.3k |
| 3 | Adventhealth South Overland Park Overland Park, KS fee schedule · outpatient | 1 | $7.3k | $7.3k | — | — | — | $7.3k – $7.3k |
| 4 | Amisub of South Carolina, Inc. Fort Mill, SC fee schedule · outpatient | 1 | $8.0k | $8.0k | — | — | — | $8.0k – $8.0k |
| 5 | Beavercreek Medical Center Springfield, OH fee schedule · outpatient | 2 | $12.1k | $12.1k | — | — | — | $12.1k – $12.1k |
| 6 | Bethesda Hospital Inc. Lebanon, OH facility · fee schedule · outpatient | 1 | $10.6k | $10.6k | — | — | — | $10.6k – $10.6k |
| 7 | CHRISTUS Hospital - Orange Orange, TX case rate · outpatient | 5 | $4.1k | $4.0k | $165 | 4% | — | $3.7k – $4.1k |
| 8 | CHRISTUS West Beaumont Beaumont, TX case rate · outpatient | 5 | $4.1k | $4.0k | $165 | 4% | — | $3.7k – $4.1k |
| 9 | CLAIBORNE MEDICAL CENTER Tazewell, TN case rate · outpatient | 1 | $2.8k | $2.8k | — | — | — | $2.8k – $2.8k |
| 10 | CUMBERLAND MEDICAL CENTER, INC. Crossville, TN case rate · outpatient | 1 | $2.8k | $2.8k | — | — | — | $2.8k – $2.8k |
| 11 | Christus Health Southeast Texas Beaumont, TX case rate · outpatient | 5 | $4.1k | $4.0k | $165 | 4% | — | $3.7k – $4.1k |
| 12 | Christus Health Southeast Texas Port Arthur, TX case rate · outpatient | 5 | $4.1k | $4.0k | $165 | 4% | — | $3.7k – $4.1k |
| 13 | Clinton Memorial Hospital Wilmington, OH fee schedule · outpatient | 1 | $10.6k | $10.6k | — | — | — | $10.6k – $10.6k |
| 14 | Dayton Osteopathic Hospital Dayton, OH fee schedule · outpatient | 2 | $12.1k | $12.1k | — | — | — | $12.1k – $12.1k |
| 15 | Denver Health and Hospital Authority Denver, CO facility · fee schedule · outpatient | 1 | $5.4k | $5.4k | — | — | — | $5.4k – $5.4k |
| 16 | FORT LOUDOUN MEDICAL CENTER Lenoir City, TN case rate · outpatient | 1 | $2.8k | $2.8k | — | — | — | $2.8k – $2.8k |
| 17 | FORT SANDERS REGIONAL MEDICAL CENTER Knoxville, TN case rate · outpatient | 1 | $2.8k | $2.8k | — | — | — | $2.8k – $2.8k |
| 18 | Florida Coast Medical and Surgical Center, Inc. Port St. Lucie, FL fee schedule · outpatient | 3 | $1.1k | $921 | $182 | 20% | — | $663 – $1.1k |
| 19 | Fort Hamilton Hospital Hamilton, OH fee schedule · outpatient | 2 | $12.1k | $12.1k | — | — | — | $12.1k – $12.1k |
| 20 | GOOD SAMARITAN MEDICAL CENTER, LLC DBA LAFAYETTE, CO facility · case rate · outpatient | 6 | $7.6k | $7.6k | — | — | — | $7.6k – $7.6k |
| 21 | Garnet Health Medical Center Middletown, NY facility · fee schedule · outpatient | 1 | $3.1k | $3.1k | — | — | — | $3.1k – $3.1k |
| 22 | Greene Memorial Hospital Inc Xenia, OH fee schedule · outpatient | 2 | $12.1k | $12.1k | — | — | — | $12.1k – $12.1k |
| 23 | INTERMOUNTAIN FRONT RANGE INC. DBA INTERMOUNTAIN HEALTH LUTHERAN HOSPITAL WHEAT RIDGE, CO facility · case rate · outpatient | 7 | $7.6k | $7.6k | — | — | — | $7.6k – $7.6k |
| 24 | Jefferson Health - Northeast Langhorne, PA facility · fee schedule · outpatient | 2 | $7.9k | $7.9k | $309 | 4% | — | $7.6k – $8.2k |
| 25 | Jefferson Health - Northeast Philadelphia, PA facility · fee schedule · outpatient | 2 | $7.9k | $7.9k | $309 | 4% | — | $7.6k – $8.2k |
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