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
Fee Schedule
Low
$0
Average
$93
Median
$10
High
$3.0k
Each hospital's average Aetna rate, under the methodology and billing class chosen below.
46 hospitals; the 90th percentile is 36.8× 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.
Filter by billing methodology
Filter by billing class
62 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 | ALBANY MEDICAL CENTER HOSPITAL Albany, NY facility · percent of total billed charges · outpatientfrom % of charges | 1 | $0 | $0 | — | — | — | $0 – $0 |
| 2 | Beaufort Memorial Hospital Beaufort, SC facility · percent of total billed charges · inpatientfrom % of charges | 1 | $130 | $130 | $2 | 2% | — | $127 – $132 |
| 3 | Beaufort Memorial Hospital Beaufort, SC facility · percent of total billed charges · outpatientfrom % of charges | 1 | $126 | $126 | $2 | 2% | — | $124 – $129 |
| 4 | Cheshire Medical Center Keene, NH professional · fee schedule · outpatient | 2 | $2 | $2 | $0 | 5% | — | $2 – $2 |
| 5 | Conway Hospital, Inc. Conway, SC professional · fee schedule · outpatient | 1 | $49 | $49 | — | — | — | $49 – $49 |
| 6 | Covenant Medical Center Lubbock, TX fee schedule · outpatient | 1 | $9 | $9 | — | — | — | $9 – $9 |
| 7 | Covenant Medical Center Inc Saginaw, MI professional · fee schedule · both | 1 | $2 | $2 | — | — | — | $2 – $2 |
| 8 | Covenant Medical Center Inc Saginaw, MI professional · fee schedule · both | 1 | $2 | $2 | — | — | — | $2 – $2 |
| 9 | Fox Chase Cancer Center Philadelphia, PA facility · percent of total billed charges · outpatientfrom % of charges | 3 | $8 | $8 | $1 | 16% | — | $6 – $9 |
| 10 | Garnet Health Medical Center Middletown, NY facility · fee schedule · outpatient | 1 | $2 | $2 | — | — | — | $2 – $2 |
| 11 | Garnet Health Medical Center Catskills Harris, NY facility · fee schedule · outpatient | 1 | $2 | $2 | — | — | — | $2 – $2 |
| 12 | Henry Ford Health System West Bloomfield, MI facility · percent of total billed charges · inpatientfrom % of charges | 1 | $9 | $9 | $6 | 69% | — | $3 – $15 |
| 13 | Henry Ford Health System West Bloomfield, MI facility · percent of total billed charges · outpatientfrom % of charges | 1 | $10 | $10 | $7 | 69% | — | $3 – $17 |
| 14 | Henry Ford Health System Plymouth, MI facility · percent of total billed charges · inpatientfrom % of charges | 1 | $9 | $9 | $6 | 69% | — | $3 – $16 |
| 15 | Henry Ford Health System Plymouth, MI facility · percent of total billed charges · outpatientfrom % of charges | 1 | $11 | $11 | $7 | 69% | — | $3 – $18 |
| 16 | Henry Ford Macomb Hospital Corporation Clinton Twp, MI facility · percent of total billed charges · inpatientfrom % of charges | 1 | $9 | $9 | $6 | 69% | — | $3 – $15 |
| 17 | Henry Ford Macomb Hospital Corporation Clinton Twp, MI facility · percent of total billed charges · outpatientfrom % of charges | 1 | $10 | $10 | $7 | 68% | — | $3 – $17 |
| 18 | Henry Ford Wyandotte Hospital Brownstown Charter Twp., MI facility · percent of total billed charges · inpatientfrom % of charges | 1 | $9 | $9 | $6 | 69% | — | $3 – $15 |
| 19 | Henry Ford Wyandotte Hospital Brownstown Charter Twp., MI facility · percent of total billed charges · outpatientfrom % of charges | 1 | $10 | $10 | $7 | 69% | — | $3 – $17 |
| 20 | Kalkaska Memorial Health Center Kalkaska, MI facility · percent of total billed charges · inpatientfrom % of charges | 1 | $67 | $67 | — | — | — | $67 – $67 |
| 21 | Kalkaska Memorial Health Center Kalkaska, MI facility · percent of total billed charges · outpatientfrom % of charges | 2 | $50 | $50 | $18 | 36% | — | $32 – $67 |
| 22 | Lubbock Heritage Hospital LLC Lubbock, TX fee schedule · outpatient | 1 | $9 | $9 | — | — | — | $9 – $9 |
| 23 | MEDICAL CITY ARLINGTON GRAND PRAIRIE, TX percent of total billed charges · outpatientfrom % of charges | 6 | $7 | $10 | $6 | 63% | — | $4 – $23 |
| 24 | MEDICAL CITY FORT WORTH FORT WORTH, TX percent of total billed charges · outpatientfrom % of charges | 8 | $106 | $140 | $63 | 45% | — | $62 – $225 |
| 25 | MEDICAL CITY LAS COLINAS Irving, TX percent of total billed charges · outpatientfrom % of charges | 6 | $1 | $2 | $1 | 63% | — | $1 – $5 |
← Payers reporting HCPCS S0030 · Snapshot 20261112T181611Z-3fa9fb76