1001515 — Ot - Whfo W/jts Cust Fab L3806
Cite this view
APA (7th ed.)
HANK Price Transparency. (n.d.). OT - WHFO W/JTS CUST FAB L3806 (CDM 1001515) negotiated rates. PPMan price-transparency data, derived from CMS-required hospital MRFs. Retrieved , from http://ppman.hank.ai/transparency/code/1001515?code_type=CDM
MLA (9th ed.)
“OT - WHFO W/JTS CUST FAB L3806 (CDM 1001515) negotiated rates.” HANK Price Transparency, http://ppman.hank.ai/transparency/code/1001515?code_type=CDM. Accessed .
Chicago (notes-bibliography)
“OT - WHFO W/JTS CUST FAB L3806 (CDM 1001515) negotiated rates,” HANK Price Transparency, accessed , http://ppman.hank.ai/transparency/code/1001515?code_type=CDM.
Source: PPMan price-transparency data, derived from CMS-required hospital machine-readable files (45 CFR 180). See methodology.
Usually $128–$853 (25th–75th percentile) across 3 hospitals · 32 payers.
“Negotiated” is the hospital’s negotiated facility rate for this CDM 1001515 — the consumer-grade median across the country. It covers the facility charge only; the surgeon’s and anesthesiologist’s fees are billed separately.
Per-month price trends are temporarily unavailable while we rebuild them on quality-filtered rates. The medians, percentiles, and per-hospital rates on this page are the quality-filtered figures.
Hospital rates (per row)
Showing consumer-grade rates only. Flagged / outlier filings (excluded from the medians above) are hidden — tick “Show flagged / outlier rates” to include them.
| Hospital | Payer | Plan | Negotiated rate | Gross | Cash | Observed | Source |
|---|---|---|---|---|---|---|---|
| ASCENSION PROVIDENCE Both | SWHP RIGHTCARE STAR | 818_SWHP RIGHTCARE STAR INPATIENT 20240901 | $127.89 | $1,421.00 | $511.56 | 2026-01-01 | MRF ↗ |
| ASCENSION PROVIDENCE Outpatient | SUPERIOR STAR PLUS | 907_SUPERIOR STAR PLUS OUTPATIENT 20241201 | $127.89 | $1,421.00 | $511.56 | 2026-01-01 | MRF ↗ |
| ASCENSION PROVIDENCE Both | UHC STAR | 929_UHC STAR INPATIENT 20250701 | $127.89 | $1,421.00 | $511.56 | 2026-01-01 | MRF ↗ |
| ASCENSION PROVIDENCE Both | MOLINA MEDICAID REPLACEMENT CHIP | 891_MOLINA CHIP INPATIENT 20240901 | $127.89 | $1,421.00 | $511.56 | 2026-01-01 | MRF ↗ |
| ASCENSION PROVIDENCE Outpatient | MOLINA MEDICAID REPLACEMENT CHIP | 908_MOLINA CHIP OUTPATIENT 20241201 | $127.89 | $1,421.00 | $511.56 | 2026-01-01 | MRF ↗ |
| ASCENSION PROVIDENCE Outpatient | MOLINA MEDICAID REPLACEMENT CHIP | 908_MOLINA CHIP OUTPATIENT 20241201 | $127.89 | $1,421.00 | $511.56 | 2026-01-01 | MRF ↗ |
| ASCENSION PROVIDENCE Both | MOLINA MEDICAID REPLACEMENT CHIP | 891_MOLINA CHIP INPATIENT 20240901 | $127.89 | $1,421.00 | $511.56 | 2026-01-01 | MRF ↗ |
| ASCENSION PROVIDENCE Both | WELLPOINT STAR | 815_WELLPOINT (AMERIGROUP) STAR INPATIENT 20240901 | $127.89 | $1,421.00 | $511.56 | 2026-01-01 | MRF ↗ |
| ASCENSION PROVIDENCE Outpatient | SWHP RIGHTCARE STAR | 905_SWHP RIGHTCARE STAR OUTPATIENT 20241201 | $127.89 | $1,421.00 | $511.56 | 2026-01-01 | MRF ↗ |
| ASCENSION PROVIDENCE Both | MCLENNAN COUNTY INDIGENT | 933_MCLENNAN COUNTY INDIGENT INPATIENT 20250601 | $127.89 | $1,421.00 | $511.56 | 2026-01-01 | MRF ↗ |
| ASCENSION PROVIDENCE Both | BCBS STAR | 974_BCBS STAR INPATIENT 20240901 | $127.89 | $1,421.00 | $511.56 | 2026-01-01 | MRF ↗ |
| ASCENSION PROVIDENCE Outpatient | UHC STAR PLUS | 906_UHC STAR PLUS OUTPATIENT 20241201 | $127.89 | $1,421.00 | $511.56 | 2026-01-01 | MRF ↗ |
| ASCENSION PROVIDENCE Both | UHC STAR KIDS | 894_UHC STAR KIDS INPATIENT 20240901 | $127.89 | $1,421.00 | $511.56 | 2026-01-01 | MRF ↗ |
| ASCENSION PROVIDENCE Outpatient | UHC STAR KIDS | 909_UHC STAR KIDS OUTPATIENT 20241201 | $127.89 | $1,421.00 | $511.56 | 2026-01-01 | MRF ↗ |
| ASCENSION PROVIDENCE Both | SUPERIOR CHIP/CHIP PERINATE | 898_SUPERIOR CHIP INPATIENT 20240901 | $127.89 | $1,421.00 | $511.56 | 2026-01-01 | MRF ↗ |
| ASCENSION PROVIDENCE Both | SWHP RIGHTCARE STAR | 818_SWHP RIGHTCARE STAR INPATIENT 20240901 | $127.89 | $1,421.00 | $511.56 | 2026-01-01 | MRF ↗ |
| ASCENSION PROVIDENCE Both | UHC STAR PLUS | 852_UHC STAR PLUS INPATIENT 20240901 | $127.89 | $1,421.00 | $511.56 | 2026-01-01 | MRF ↗ |
| ASCENSION PROVIDENCE Outpatient | SUPERIOR CHIP/CHIP PERINATE | 910_SUPERIOR CHIP OUTPATIENT 20241201 | $127.89 | $1,421.00 | $511.56 | 2026-01-01 | MRF ↗ |
| ASCENSION PROVIDENCE Outpatient | BCBS STAR | 975_BCBS STAR OUTPATIENT 20241201 | $127.89 | $1,421.00 | $511.56 | 2026-01-01 | MRF ↗ |
| ASCENSION PROVIDENCE Outpatient | UHC STAR | 928_UHC STAR OUTPATIENT 20250701 | $127.89 | $1,421.00 | $511.56 | 2026-01-01 | MRF ↗ |
| ASCENSION PROVIDENCE Both | UHC STAR PLUS | 852_UHC STAR PLUS INPATIENT 20240901 | $127.89 | $1,421.00 | $511.56 | 2026-01-01 | MRF ↗ |
| ASCENSION PROVIDENCE Outpatient | UHC STAR PLUS | 906_UHC STAR PLUS OUTPATIENT 20241201 | $127.89 | $1,421.00 | $511.56 | 2026-01-01 | MRF ↗ |
| ASCENSION PROVIDENCE Outpatient | BCBS STAR | 975_BCBS STAR OUTPATIENT 20241201 | $127.89 | $1,421.00 | $511.56 | 2026-01-01 | MRF ↗ |
| ASCENSION PROVIDENCE Both | BCBS STAR | 974_BCBS STAR INPATIENT 20240901 | $127.89 | $1,421.00 | $511.56 | 2026-01-01 | MRF ↗ |
| ASCENSION PROVIDENCE Outpatient | UHC STAR | 928_UHC STAR OUTPATIENT 20250701 | $127.89 | $1,421.00 | $511.56 | 2026-01-01 | MRF ↗ |
| ASCENSION PROVIDENCE Both | UHC STAR | 929_UHC STAR INPATIENT 20250701 | $127.89 | $1,421.00 | $511.56 | 2026-01-01 | MRF ↗ |
| ASCENSION PROVIDENCE Outpatient | SWHP RIGHTCARE STAR | 905_SWHP RIGHTCARE STAR OUTPATIENT 20241201 | $127.89 | $1,421.00 | $511.56 | 2026-01-01 | MRF ↗ |
| ASCENSION PROVIDENCE Outpatient | SUPERIOR STAR | 904_SUPERIOR STAR OUTPATIENT 20241201 | $127.89 | $1,421.00 | $511.56 | 2026-01-01 | MRF ↗ |
| ASCENSION PROVIDENCE Both | SUPERIOR STAR | 817_SUPERIOR STAR INPATIENT 20240901 | $127.89 | $1,421.00 | $511.56 | 2026-01-01 | MRF ↗ |
| ASCENSION PROVIDENCE Outpatient | SUPERIOR STAR PLUS | 907_SUPERIOR STAR PLUS OUTPATIENT 20241201 | $127.89 | $1,421.00 | $511.56 | 2026-01-01 | MRF ↗ |
| ASCENSION PROVIDENCE Both | SUPERIOR STAR PLUS | 856_SUPERIOR STAR PLUS INPATIENT 20240901 | $127.89 | $1,421.00 | $511.56 | 2026-01-01 | MRF ↗ |
| ASCENSION PROVIDENCE Both | MEDICAID REPLACEMENT 100% | 816_MEDICAID REPLACEMENT 100% INPATIENT 20240901 | $127.89 | $1,421.00 | $511.56 | 2026-01-01 | MRF ↗ |
| ASCENSION PROVIDENCE Both | SUPERIOR STAR | 817_SUPERIOR STAR INPATIENT 20240901 | $127.89 | $1,421.00 | $511.56 | 2026-01-01 | MRF ↗ |
| ASCENSION PROVIDENCE Outpatient | WELLPOINT STAR | 902_WELLPOINT (AMERIGROUP) STAR OUTPATIENT 20241201 | $127.89 | $1,421.00 | $511.56 | 2026-01-01 | MRF ↗ |
| ASCENSION PROVIDENCE Both | WELLPOINT STAR | 815_WELLPOINT (AMERIGROUP) STAR INPATIENT 20240901 | $127.89 | $1,421.00 | $511.56 | 2026-01-01 | MRF ↗ |
| ASCENSION PROVIDENCE Outpatient | SUPERIOR STAR | 904_SUPERIOR STAR OUTPATIENT 20241201 | $127.89 | $1,421.00 | $511.56 | 2026-01-01 | MRF ↗ |
| ASCENSION PROVIDENCE Outpatient | MEDICAID REPLACEMENT 100% | 903_MEDICAID REPLACEMENT 100% OUTPATIENT 20241201 | $127.89 | $1,421.00 | $511.56 | 2026-01-01 | MRF ↗ |
| ASCENSION PROVIDENCE Both | MEDICAID REPLACEMENT 100% | 816_MEDICAID REPLACEMENT 100% INPATIENT 20240901 | $127.89 | $1,421.00 | $511.56 | 2026-01-01 | MRF ↗ |
| ASCENSION PROVIDENCE Both | SUPERIOR CHIP/CHIP PERINATE | 898_SUPERIOR CHIP INPATIENT 20240901 | $127.89 | $1,421.00 | $511.56 | 2026-01-01 | MRF ↗ |
| ASCENSION PROVIDENCE Outpatient | SUPERIOR CHIP/CHIP PERINATE | 910_SUPERIOR CHIP OUTPATIENT 20241201 | $127.89 | $1,421.00 | $511.56 | 2026-01-01 | MRF ↗ |
| ASCENSION PROVIDENCE Outpatient | UHC STAR KIDS | 909_UHC STAR KIDS OUTPATIENT 20241201 | $127.89 | $1,421.00 | $511.56 | 2026-01-01 | MRF ↗ |
| ASCENSION PROVIDENCE Both | UHC STAR KIDS | 894_UHC STAR KIDS INPATIENT 20240901 | $127.89 | $1,421.00 | $511.56 | 2026-01-01 | MRF ↗ |
| ASCENSION PROVIDENCE Outpatient | MEDICAID REPLACEMENT 100% | 903_MEDICAID REPLACEMENT 100% OUTPATIENT 20241201 | $127.89 | $1,421.00 | $511.56 | 2026-01-01 | MRF ↗ |
| ASCENSION PROVIDENCE Both | SUPERIOR STAR PLUS | 856_SUPERIOR STAR PLUS INPATIENT 20240901 | $127.89 | $1,421.00 | $511.56 | 2026-01-01 | MRF ↗ |
| ASCENSION PROVIDENCE Outpatient | WELLPOINT STAR | 902_WELLPOINT (AMERIGROUP) STAR OUTPATIENT 20241201 | $127.89 | $1,421.00 | $511.56 | 2026-01-01 | MRF ↗ |
| ASCENSION PROVIDENCE Both | MCLENNAN COUNTY INDIGENT | 933_MCLENNAN COUNTY INDIGENT INPATIENT 20250601 | $127.89 | $1,421.00 | $511.56 | 2026-01-01 | MRF ↗ |
| ASCENSION PROVIDENCE Outpatient | HEALTHSMART | 808_HEALTHSMART PREFERRED CARE PPO | $142.10 | $1,421.00 | $511.56 | 2026-01-01 | MRF ↗ |
| ASCENSION PROVIDENCE Outpatient | HEALTHSMART | 808_HEALTHSMART PREFERRED CARE PPO | $142.10 | $1,421.00 | $511.56 | 2026-01-01 | MRF ↗ |
| ASCENSION PROVIDENCE Outpatient | MCLENNAN COUNTY INDIGENT | 936_MCLENNAN COUNTY INDIGENT OUTPATIENT 20250601 | $184.73 | $1,421.00 | $511.56 | 2026-01-01 | MRF ↗ |
| ASCENSION PROVIDENCE Outpatient | MCLENNAN COUNTY INDIGENT | 936_MCLENNAN COUNTY INDIGENT OUTPATIENT 20250601 | $184.73 | $1,421.00 | $511.56 | 2026-01-01 | MRF ↗ |
| ASCENSION PROVIDENCE Outpatient | SMARTHEALTH | 824_SMARTHEALTH INPATIENT 20241001 | $269.99 | $1,421.00 | $511.56 | 2026-01-01 | MRF ↗ |
| ASCENSION PROVIDENCE Outpatient | SMARTHEALTH | 875_SMARTHEALTH OUTPATIENT 20250101 | $269.99 | $1,421.00 | $511.56 | 2026-01-01 | MRF ↗ |
| ASCENSION PROVIDENCE Outpatient | SMARTHEALTH | 824_SMARTHEALTH INPATIENT 20241001 | $269.99 | $1,421.00 | $511.56 | 2026-01-01 | MRF ↗ |
| ASCENSION PROVIDENCE Outpatient | SMARTHEALTH | 875_SMARTHEALTH OUTPATIENT 20250101 | $269.99 | $1,421.00 | $511.56 | 2026-01-01 | MRF ↗ |
| ASCENSION PROVIDENCE Outpatient | SELF PAY | 924_UNINSURED DISCOUNT 20250701 | $511.56 | $1,421.00 | $511.56 | 2026-01-01 | MRF ↗ |
| ASCENSION PROVIDENCE Outpatient | BCBS MYBLUEHEALTH | 872_BLUE CROSS BLUE SHIELD MYBLUEHEATH 20250101 | $511.56 | $1,421.00 | $511.56 | 2026-01-01 | MRF ↗ |
| ASCENSION PROVIDENCE Outpatient | BCBS MYBLUEHEALTH | 872_BLUE CROSS BLUE SHIELD MYBLUEHEATH 20250101 | $511.56 | $1,421.00 | $511.56 | 2026-01-01 | MRF ↗ |
| ASCENSION PROVIDENCE Outpatient | SELF PAY | 924_UNINSURED DISCOUNT 20250701 | $511.56 | $1,421.00 | $511.56 | 2026-01-01 | MRF ↗ |
| ASCENSION PROVIDENCE Outpatient | AETNA | 935_AETNA 20250801 | $596.82 | $1,421.00 | $511.56 | 2026-01-01 | MRF ↗ |
| ASCENSION PROVIDENCE Outpatient | AETNA | 935_AETNA 20250801 | $596.82 | $1,421.00 | $511.56 | 2026-01-01 | MRF ↗ |
| ASCENSION PROVIDENCE Outpatient | BCBS ADVANTAGE HMO | 871_BLUE CROSS BLUE SHIELD ADVANTAGE HMO 20250101 | $625.24 | $1,421.00 | $511.56 | 2026-01-01 | MRF ↗ |
| ASCENSION PROVIDENCE Outpatient | BCBS ADVANTAGE HMO | 871_BLUE CROSS BLUE SHIELD ADVANTAGE HMO 20250101 | $625.24 | $1,421.00 | $511.56 | 2026-01-01 | MRF ↗ |
| ASCENSION PROVIDENCE Outpatient | BCBS ESSENTIALS HMO | 870_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101 | $667.87 | $1,421.00 | $511.56 | 2026-01-01 | MRF ↗ |
| ASCENSION PROVIDENCE Outpatient | BCBS ESSENTIALS HMO | 870_BLUE CROSS BLUE SHIELD HMO ESSENTIALS 20250101 | $667.87 | $1,421.00 | $511.56 | 2026-01-01 | MRF ↗ |
| ASCENSION PROVIDENCE Outpatient | UHC | 943_UNITED HEALTHCARE 20250701 | $753.13 | $1,421.00 | $511.56 | 2026-01-01 | MRF ↗ |
| ASCENSION PROVIDENCE Outpatient | UHC | 943_UNITED HEALTHCARE 20250701 | $753.13 | $1,421.00 | $511.56 | 2026-01-01 | MRF ↗ |
| ASCENSION PROVIDENCE Outpatient | SWHP MANAGED CARE | 841_SCOTT & WHITE HEALTH PLAN 20241001 | $767.34 | $1,421.00 | $511.56 | 2026-01-01 | MRF ↗ |
| ASCENSION PROVIDENCE Outpatient | BCBS PPO | 869_BLUE CROSS BLUE SHIELD PPO 20250101 | $767.34 | $1,421.00 | $511.56 | 2026-01-01 | MRF ↗ |
| ASCENSION PROVIDENCE Outpatient | BCBS PPO | 869_BLUE CROSS BLUE SHIELD PPO 20250101 | $767.34 | $1,421.00 | $511.56 | 2026-01-01 | MRF ↗ |
| ASCENSION PROVIDENCE Outpatient | SWHP MANAGED CARE | 841_SCOTT & WHITE HEALTH PLAN 20241001 | $767.34 | $1,421.00 | $511.56 | 2026-01-01 | MRF ↗ |
| ASCENSION PROVIDENCE Outpatient | CIGNA | 930_CIGNA 20250701 | $809.97 | $1,421.00 | $511.56 | 2026-01-01 | MRF ↗ |
| ASCENSION PROVIDENCE Outpatient | CIGNA | 930_CIGNA 20250701 | $809.97 | $1,421.00 | $511.56 | 2026-01-01 | MRF ↗ |
| ASCENSION PROVIDENCE Outpatient | HUMANA | 644_HUMANA HMO PPO 20230701 | $980.49 | $1,421.00 | $511.56 | 2026-01-01 | MRF ↗ |
| ASCENSION PROVIDENCE Outpatient | HUMANA | 644_HUMANA HMO PPO 20230701 | $980.49 | $1,421.00 | $511.56 | 2026-01-01 | MRF ↗ |
| ASCENSION PROVIDENCE Outpatient | HOSPICE COMMUNITY | 611_COMMUNITY HEALTHPLAN OF TEXAS-PROVIDENCE HOSPICE 20201105 | $994.70 | $1,421.00 | $511.56 | 2026-01-01 | MRF ↗ |
| ASCENSION PROVIDENCE Outpatient | HOSPICE COMMUNITY | 611_COMMUNITY HEALTHPLAN OF TEXAS-PROVIDENCE HOSPICE 20201105 | $994.70 | $1,421.00 | $511.56 | 2026-01-01 | MRF ↗ |
| ASCENSION PROVIDENCE Outpatient | COVENTRY/FIRST HEALTH | 102_FIRSTHEALTH 20130101 | $1,037.33 | $1,421.00 | $511.56 | 2026-01-01 | MRF ↗ |
| ASCENSION PROVIDENCE Outpatient | COVENTRY/FIRST HEALTH | 102_FIRSTHEALTH 20130101 | $1,037.33 | $1,421.00 | $511.56 | 2026-01-01 | MRF ↗ |
| ASCENSION PROVIDENCE Outpatient | PHCS | 376_PHCS 20191001 | $1,065.75 | $1,421.00 | $511.56 | 2026-01-01 | MRF ↗ |
| ASCENSION PROVIDENCE Outpatient | PHCS | 376_PHCS 20191001 | $1,065.75 | $1,421.00 | $511.56 | 2026-01-01 | MRF ↗ |
| ASCENSION PROVIDENCE Outpatient | USA HEALTHNET | 128_USA HEALTHNET 20130101 | $1,250.48 | $1,421.00 | $511.56 | 2026-01-01 | MRF ↗ |
| ASCENSION PROVIDENCE Outpatient | USA HEALTHNET | 128_USA HEALTHNET 20130101 | $1,250.48 | $1,421.00 | $511.56 | 2026-01-01 | MRF ↗ |
| ASCENSION PROVIDENCE Both | CDM DEFAULT - NON-NEGOTIATED RATE | CDM DEFAULT - NON-NEGOTIATED RATE | $1,421.00 | $1,421.00 | $511.56 | 2026-01-01 | MRF ↗ |
| ASCENSION PROVIDENCE Outpatient | HOSPICE COMPASSUS | 819_HOSPICE COMPASSUS 20241001 | $1,421.00 | $1,421.00 | $511.56 | 2026-01-01 | MRF ↗ |
| ASCENSION PROVIDENCE Both | CDM DEFAULT - NON-NEGOTIATED RATE | CDM DEFAULT - NON-NEGOTIATED RATE | $1,421.00 | $1,421.00 | $511.56 | 2026-01-01 | MRF ↗ |
| ASCENSION PROVIDENCE Outpatient | HOSPICE COMPASSUS | 819_HOSPICE COMPASSUS 20241001 | $1,421.00 | $1,421.00 | $511.56 | 2026-01-01 | MRF ↗ |
| ORANGE CITY AREA HEALTH SYSTEM Outpatient | WELLMARK HMO | WELLMARK HMO | $2,110.50 | $4,221.00 | $3,376.80 | 2026-03-13 | MRF ↗ |
| ORANGE CITY AREA HEALTH SYSTEM Outpatient | WELLMARK PPO - ALL OTHER PLANS | WELLMARK PPO - ALL OTHER PLANS | $2,110.50 | $4,221.00 | $3,376.80 | 2026-03-13 | MRF ↗ |
| ORANGE CITY AREA HEALTH SYSTEM Outpatient | HEALTH PARTNERS OPEN | HEALTH PARTNERS OPEN | $3,798.90 | $4,221.00 | $3,376.80 | 2026-03-13 | MRF ↗ |
| ORANGE CITY AREA HEALTH SYSTEM Outpatient | MIDLANDS CHOICE-ALL PLANS | MIDLANDS CHOICE-ALL PLANS | $3,798.90 | $4,221.00 | $3,376.80 | 2026-03-13 | MRF ↗ |
| ORANGE CITY AREA HEALTH SYSTEM Outpatient | UHC ALL PAYER-ALL PLANS | UHC ALL PAYER-ALL PLANS | $3,798.90 | $4,221.00 | $3,376.80 | 2026-03-13 | MRF ↗ |
| ORANGE CITY AREA HEALTH SYSTEM Outpatient | HEALTH PARTNERS COORDINATED-ALL OTHER PLANS | HEALTH PARTNERS COORDINATED-ALL OTHER PLANS | $3,798.90 | $4,221.00 | $3,376.80 | 2026-03-13 | MRF ↗ |
| ORANGE CITY AREA HEALTH SYSTEM Outpatient | SANFORD HEALTH-ALL PLANS | SANFORD HEALTH-ALL PLANS | $4,009.95 | $4,221.00 | $3,376.80 | 2026-03-13 | MRF ↗ |
| ORANGE CITY AREA HEALTH SYSTEM Outpatient | AVERA-ALL PLANS | AVERA-ALL PLANS | $4,094.37 | $4,221.00 | $3,376.80 | 2026-03-13 | MRF ↗ |
| JAMESTOWN REGIONAL MEDICAL CENTER Outpatient | Aetna | Commercial | $7,680.00 | $10,972.00 | $8,778.00 | 2026-05-22 | MRF ↗ |
| JAMESTOWN REGIONAL MEDICAL CENTER Outpatient | Blue Cross Blue Shield North Dakota | Commercial | $10,972.00 | $10,972.00 | $8,778.00 | 2026-05-22 | MRF ↗ |