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
Clolistimethate sodium, via DME
Low
$0
Average
$27
Median
$1
High
$181
Each hospital's average Aetna rate, under the methodology and billing class chosen below.
70 hospitals; the 90th percentile is 623.6× 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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72 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 | Acadia Hospital Bangor, ME professional · fee schedule · outpatient | 1 | $0 | $0 | — | — | — | $0 – $0 |
| 2 | Allen Memorial Hospital Corporation Waterloo, IA fee schedule · both | 2 | $1 | $1 | $0 | 1% | — | $1 – $1 |
| 3 | Alta Newport Hospital, LLC Tustin, CA facility · case rate · outpatient | 2 | $1 | $1 | — | — | — | $1 – $1 |
| 4 | Blue Hill Memorial Hospital Hill, ME professional · fee schedule · outpatient | 1 | $0 | $0 | — | — | — | $0 – $0 |
| 5 | COMMUNITY MEMORIAL HOSPITAL Hill, VA case rate · outpatient | 1 | $181 | $181 | — | — | — | $181 – $181 |
| 6 | Central Iowa Hospital Corporation Des Moines, IA fee schedule · both | 2 | $1 | $1 | — | — | — | $1 – $1 |
| 7 | Central Iowa Hospital Corporation West Des Moines, IA fee schedule · both | 2 | $1 | $1 | — | — | — | $1 – $1 |
| 8 | Charles A. Dean Memorial Hospital Greenville, ME professional · fee schedule · outpatient | 1 | $0 | $0 | — | — | — | $0 – $0 |
| 9 | Cheshire Medical Center Keene, NH professional · fee schedule · outpatient | 2 | $0 | $0 | — | — | — | $0 – $0 |
| 10 | Children's Hospital of Philadelphia, The Philadelphia, PA percent of total billed charges · bothfrom % of charges | 1 | $108 | $108 | — | — | — | $108 – $108 |
| 11 | Cleveland Clinic Weston Hospital Nonprofit Corporation Weston, FL facility · case rate · outpatient | 1 | $93 | $93 | — | — | — | $93 – $93 |
| 12 | Clifton Springs Hospital And Clinic Clifton Springs, NY facility · fee schedule · outpatient | 2 | $0 | $0 | — | — | — | $0 – $0 |
| 13 | Covenant Medical Center Lubbock, TX fee schedule · outpatient | 1 | $2 | $2 | — | — | — | $2 – $2 |
| 14 | Doctors’ Hospital of Williamsburg Williamsburg, VA fee schedule · outpatient | 1 | $162 | $162 | — | — | — | $162 – $162 |
| 15 | ERIE COUNTY MEDICAL CENTER CORPORATION Buffalo, NY fee schedule · outpatient | 1 | $0 | $0 | — | — | — | $0 – $0 |
| 16 | Eastern Maine Medical Center Bangor, ME facility · case rate · outpatient | 1 | $0 | $0 | — | — | — | $0 – $0 |
| 17 | Eastern Maine Medical Center Bangor, ME professional · fee schedule · outpatient | 2 | $0 | $0 | — | — | — | $0 – $0 |
| 18 | Garnet Health Medical Center Middletown, NY facility · fee schedule · outpatient | 1 | $1 | $1 | — | — | — | $1 – $1 |
| 19 | Garnet Health Medical Center Catskills Harris, NY facility · fee schedule · outpatient | 1 | $1 | $1 | — | — | — | $1 – $1 |
| 20 | Gouverneur Hospital Gouverneur, NY facility · fee schedule · outpatient | 1 | $0 | $0 | — | — | — | $0 – $0 |
| 21 | Grinnell Regional Medical Center Grinnell, IA fee schedule · both | 2 | $1 | $1 | — | — | — | $1 – $1 |
| 22 | HCA HOUSTON HEALTHCARE CLEAR LAKE WEBSTER, TX percent of total billed charges · outpatientfrom % of charges | 1 | $0 | $0 | — | — | — | $0 – $0 |
| 23 | Hardin County General Hospital Savannah, TN facility · fee schedule · outpatient | 1 | $0 | $0 | — | — | — | $0 – $0 |
| 24 | Hoag Memorial Hospital Presbyterian Irvine, CA facility · fee schedule · outpatient | 1 | $1 | $1 | — | — | — | $1 – $1 |
| 25 | INDIAN RIVER MEMORIAL HOSPITAL INC Vero Beach, FL facility · case rate · outpatient | 1 | $86 | $86 | — | — | — | $86 – $86 |
← Payers reporting HCPCS S0142 · Snapshot 20261112T181611Z-3fa9fb76