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
Tlso flex trnk sj-t9 pre ots
Devils Lake, ND
See all hospitals reporting HCPCS L0455 →Price type
Altru Hospital Devils Lake’s median price of $340 is 26% above the median hospital's median price ($270), higher than 76% of the 833 hospitals reporting HCPCS L0455. The highlighted bar is where this hospital falls; shaded is the middle 50% of hospitals.
Negotiated rates from the hospital’s own file: 5 payers, 10 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 | Medica medicaid managed care plan facility · fee schedule · outpatient | $87 | $87 | — | — | — | $87 – $87 |
| 2 | Medica medicaid managed care plan – hmo facility · fee schedule · outpatient | $87 | $87 | — | — | — | $87 – $87 |
| 3 | Medica medicare managed care plan facility · fee schedule · outpatient | $158 | $158 | — | — | — | $158 – $158 |
| 4 | Medica all commercial plans facility · fee schedule · outpatient | $257 | $257 | — | — | — | $257 – $257 |
| 5 | Aetna medicare managed care plan facility · fee schedule · outpatient | $264 | $264 | — | — | — | $264 – $264 |
| 6 | Blue Cross Blue Shield all commercial plans facility · fee schedule · outpatient | $340 | $340 | — | — | — | $340 – $340 |
| 7 | Blue Cross Blue Shield medicaid managed care plan facility · fee schedule · outpatient | $340 | $340 | — | — | — | $340 – $340 |
| 8 | Sanford Health Plan all commercial plans facility · fee schedule · outpatient | $361 | $361 | $53 | 15% | — | $308 – $414 |
| 9 | Aetna all commercial plans facility · fee schedule · outpatient | $376 | $376 | $99 | 26% | — | $277 – $475 |
| 10 | UnitedHealthcare all commercial plans facility · fee schedule · outpatient | $517 | $517 | — | — | — | $517 – $517 |
Last updated: Mar 1, 2026
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