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
Lutheran Monaural HA Left - HA Monaural ITC Entry
Peru, IN
See all hospitals reporting HCPCS V5255 →Price type
Dukes Health System LLC’s median price of $653 is 65% below the median hospital's median price ($1.9k), higher than 13% of the 296 hospitals reporting HCPCS V5255. The highlighted bar is where this hospital falls; shaded is the middle 50% of hospitals.
Negotiated rates from the hospital’s own file: 10 payers, 25 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 | Anthem node anthem in mcr select facility · fee schedule · outpatient | $276 | $290 | $119 | 41% | — | $157 – $453 |
| 2 | Humana node humana mcr adv facility · fee schedule · outpatient | $276 | $290 | $119 | 41% | — | $157 – $453 |
| 3 | UnitedHealthcare node uhc mcr adv facility · fee schedule · outpatient | $276 | $290 | $119 | 41% | — | $157 – $453 |
| 4 | Anthem anthem in hip facility · fee schedule · outpatient | $280 | $295 | $121 | 41% | — | $160 – $460 |
| 5 | Anthem node anthem in mcr adv facility · fee schedule · outpatient | $280 | $295 | $121 | 41% | — | $160 – $460 |
| 6 | Optum node united optum va ccn facility · per diem · outpatient | $280 | $295 | $121 | 41% | — | $160 – $460 |
| 7 | Aetna node aetna mcr adv facility · fee schedule · outpatient | $281 | $296 | $122 | 41% | — | $161 – $462 |
| 8 | Anthem node anthem essentials marketplace facility · fee schedule · outpatient | $420 | $443 | $182 | 41% | — | $240 – $690 |
| 9 | Anthem anthem in work comp facility · other · outpatient | $448 | $472 | $194 | 41% | — | $256 – $736 |
| 10 | Aetna aetna nbd facility · percent of total billed charges · inpatientfrom % of charges | $504 | $531 | $218 | 41% | — | $288 – $828 |
| 11 | Aetna aetna nbd facility · percent of total billed charges · outpatientfrom % of charges | $504 | $531 | $218 | 41% | — | $288 – $828 |
| 12 | Aetna aetna pssd jj facility · percent of total billed charges · inpatientfrom % of charges | $504 | $531 | $218 | 41% | — | $288 – $828 |
| 13 | Aetna aetna pssd jj facility · percent of total billed charges · outpatientfrom % of charges | $504 | $531 | $218 | 41% | — | $288 – $828 |
| 14 | Cigna cigna all facility · percent of total billed charges · outpatientfrom % of charges | $594 | $625 | $257 | 41% | — | $339 – $975 |
| 15 | Aetna aetna all facility · percent of total billed charges · outpatientfrom % of charges | $666 | $702 | $288 | 41% | — | $381 – $1.1k |
| 16 | UnitedHealthcare uhc apa facility · percent of total billed charges · inpatientfrom % of charges | $689 | $726 | $298 | 41% | — | $394 – $1.1k |
| 17 | Devoted node devoted health mcr adv facility · fee schedule · outpatient | $701 | $739 | $303 | 41% | — | $401 – $1.2k |
| 18 | First Health first health facility · percent of total billed charges · inpatientfrom % of charges | $1.1k | $1.2k | $485 | 41% | — | $640 – $1.8k |
| 19 | First Health first health facility · percent of total billed charges · outpatientfrom % of charges | $1.1k | $1.2k | $485 | 41% | — | $640 – $1.8k |
| 20 | MultiPlan multiplan complementary facility · percent of total billed charges · inpatientfrom % of charges | $1.1k | $1.2k | $491 | 41% | — | $648 – $1.9k |
| 21 | MultiPlan multiplan complementary facility · percent of total billed charges · outpatientfrom % of charges | $1.1k | $1.2k | $491 | 41% | — | $648 – $1.9k |
| 22 | MultiPlan multiplan primary facility · percent of total billed charges · inpatientfrom % of charges | $1.1k | $1.2k | $491 | 41% | — | $648 – $1.9k |
| 23 | MultiPlan multiplan primary facility · percent of total billed charges · outpatientfrom % of charges | $1.1k | $1.2k | $491 | 41% | — | $648 – $1.9k |
| 24 | Cigna cigna indemnity facility · percent of total billed charges · outpatientfrom % of charges | $1.4k | $1.5k | $606 | 41% | — | $800 – $2.3k |
| 25 | Tricare node tricare facility · fee schedule · outpatient | $1.4k | $1.5k | $606 | 41% | — | $800 – $2.3k |
Last updated: Apr 1, 2026
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