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
Xcapsl ctrc rmvl w/o ecp
Wellsville, NY
See all hospitals reporting CPT 66984 →Price type
Memorial Hosp of Wm F & Gertrude F Jones A/K/A Jones Memorial Hosp’s median price of $3.1k is 12% above the median hospital's median price ($2.8k), higher than 58% of the 1,862 hospitals reporting CPT 66984. The highlighted bar is where this hospital falls; shaded is the middle 50% of hospitals.
Negotiated rates from the hospital’s own file: 7 payers, 13 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 | Highmark highmark bcbs medicaid 170201 child health plus 170204 fee schedule · outpatient | $607.20 | $607.20 | $607.20 – $607.20 |
| 2 | Aetna aetna 270002 percent of total billed charges · outpatientfrom % of charges | $1,973 | $1,973 | $1,973 – $1,973 |
| 3 | UnitedHealthcare united healthcare 515803 case rate · outpatient | $2,625 | $2,625 | $2,625 – $2,625 |
| 4 | Excellus excellus 220101, excellus simply blue 220106, excellus blue choice 220107 fee schedule · outpatient | $3,085 | $3,085 | $3,085 – $3,085 |
| 5 | Excellus excellus metal tiers 220102 fee schedule · outpatient | $3,085 | $3,085 | $3,085 – $3,085 |
| 6 | Highmark highmark bcbs medicare 130101 fee schedule · outpatient | $3,085 | $3,085 | $3,085 – $3,085 |
| 7 | Humana humana medicare 131201 fee schedule · outpatient | $3,085 | $3,085 | $3,085 – $3,085 |
| 8 | UnitedHealthcare united healthcare medicare 130901 fee schedule · outpatient | $3,085 | $3,085 | $3,085 – $3,085 |
| 9 | WellCare wellcare medicare 131001 fee schedule · outpatient | $3,085 | $3,085 | $3,085 – $3,085 |
| 10 | Aetna aetna medicare 130001 fee schedule · outpatient | $3,270 | $3,270 | $3,270 – $3,270 |
| 11 | Highmark highmark bcbs 514301 hmo / pos fee schedule · outpatient | $4,951 | $4,951 | $4,951 – $4,951 |
| 12 | Highmark highmark bcbs 514301 indemnity / ppo fee schedule · outpatient | $6,228 | $6,228 | $6,228 – $6,228 |
| 13 | Cigna mvp commercial ppo fully insured 290006, cigna healthcare (pob 182223) 514405 fee schedule · outpatient | $7,544 | $7,544 | $7,544 – $7,544 |
Last updated: Jan 1, 2026
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