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
HCHG FO PIP DIP W JOINT SPRING PREFAB OTS PR10
Ulm, MN
See all hospitals reporting HCPCS L3925 →Price type
Allina Health Systems’s median price of $55 is 12% below the median hospital's median price ($63), higher than 23% of the 1,353 hospitals reporting HCPCS L3925. The highlighted bar is where this hospital falls; shaded is the middle 50% of hospitals.
Negotiated rates from the hospital’s own file: 9 payers, 24 plan rates. A facility fee, a professional fee, a per diem and a case rate are different bills, so each is listed on its own. Open a payer to see it across hospitals.
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| # | |||||||
|---|---|---|---|---|---|---|---|
| 1 | Ucare ucare pmap (abdmnorsuv) facility · percent of total billed charges · outpatientfrom % of charges | $15 | $16 | $11 | 70% | — | $1 – $34 |
| 2 | Medica medica pmap (n) facility · percent of total billed charges · outpatientfrom % of charges | $24 | $26 | $18 | 70% | — | $1 – $54 |
| 3 | Medicaid medicaid ma (n) facility · other · outpatient | $33 | $36 | $25 | 70% | — | $1 – $74 |
| 4 | Medica medica medicare (r) facility · fee schedule · outpatient | $33 | $36 | $25 | 70% | — | $1 – $75 |
| 5 | Medica medica dual solutions (r) facility · percent of total billed charges · outpatientfrom % of charges | $34 | $37 | $25 | 70% | — | $1 – $76 |
| 6 | Blue Cross Blue Shield bc medicare (n) facility · fee schedule · outpatient | $35 | $38 | $26 | 70% | — | $1 – $79 |
| 7 | Bcbs Mn bc pmap (n) facility · other · outpatient | $43 | $43 | — | — | — | $43 – $43 |
| 8 | Aetna aetna elevate (n r) facility · percent of total billed charges · inpatientfrom % of charges | $46 | $50 | $35 | 70% | — | $2 – $103 |
| 9 | Aetna aetna elevate (n r) facility · percent of total billed charges · outpatientfrom % of charges | $46 | $50 | $35 | 70% | — | $2 – $105 |
| 10 | Aetna allina aetna medicare (n) facility · fee schedule · outpatient | $69 | $51 | $26 | 51% | — | $3 – $69 |
| 11 | Medicare medicare (n) facility · fee schedule · outpatient | $72 | $53 | $27 | 51% | — | $3 – $72 |
| 12 | Aetna aetna performance (n r) facility · percent of total billed charges · inpatientfrom % of charges | $49 | $54 | $37 | 70% | — | $2 – $112 |
| 13 | Aetna aetna performance (n r) facility · percent of total billed charges · outpatientfrom % of charges | $50 | $54 | $38 | 70% | — | $2 – $113 |
| 14 | Medica medica ubh pmap (n) facility · percent of total billed charges · outpatientfrom % of charges | $60 | $65 | $45 | 70% | — | $2 – $135 |
| 15 | Cigna hpi cigna (n) facility · other · outpatient | $61 | $66 | $46 | 70% | — | $2 – $138 |
| 16 | First Health first health (abdmnosurv) facility · percent of total billed charges · inpatientfrom % of charges | $63 | $68 | $48 | 70% | — | $2 – $142 |
| 17 | First Health first health (abdmnosurv) facility · percent of total billed charges · outpatientfrom % of charges | $63 | $68 | $48 | 70% | — | $2 – $142 |
| 18 | Medica medica ubh (n) facility · percent of total billed charges · outpatientfrom % of charges | $63 | $68 | $48 | 70% | — | $2 – $142 |
| 19 | Aetna aetna direct/indirect network (n r) facility · percent of total billed charges · inpatientfrom % of charges | $63 | $69 | $48 | 70% | — | $2 – $143 |
| 20 | Aetna aetna direct/indirect network (n r) facility · percent of total billed charges · outpatientfrom % of charges | $64 | $69 | $48 | 70% | — | $2 – $144 |
| 21 | Bcbs Mn bc state health plan (n) facility · other · outpatient | $106 | $106 | — | — | — | $106 – $106 |
| 22 | Bcbs Mn bc premier(n) facility · other · outpatient | $136 | $136 | — | — | — | $136 – $136 |
| 23 | Blue Cross Blue Shield bc aehp (n) facility · other · outpatient | $160 | $160 | — | — | — | $160 – $160 |
| 24 | Bcbs Mn bc high value/performance network (n) facility · other · outpatient | $171 | $171 | — | — | — | $171 – $171 |
Last updated: Jun 16, 2026
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