Custom shape cover bk cost at US hospitals
Custom shape cover BK · HCPCS L5704
$479.45
lowest cash price
$1,062.75
national median
$1,600.60
highest cash price
7
hospitals with a published cash price
Middle half of hospitals (25th–75th percentile) against the full range. The same procedure varies $479.45–$1,600.60 — the variation is the story.
Most expensive published cash price
$1,600.60
Ascension Columbia St. Mary's Hospital - Milwaukee Campus (Columbia St. Mary's Hospital Milwaukee, Inc.) — Milwaukee, WIMedian cash price over time
Jan 1, 2026 ($1,600.60) → Jun 1, 2026 ($1,062.75)
By state
| State | Hospitals | Lowest cash | Median | Highest |
|---|---|---|---|---|
| Alaska | 1 | not published by hospital | not published by hospital | not published by hospital |
| California | 1 | not published by hospital | not published by hospital | not published by hospital |
| Colorado | 8 | not published by hospital | not published by hospital | not published by hospital |
| Florida | 4 | not published by hospital | not published by hospital | not published by hospital |
| Georgia | 2 | not published by hospital | not published by hospital | not published by hospital |
| Illinois | 10 | not published by hospital | not published by hospital | not published by hospital |
| Iowa | 11 | not published by hospital | not published by hospital | not published by hospital |
| Kansas | 1 | not published by hospital | not published by hospital | not published by hospital |
| Maine | 7 | not published by hospital | not published by hospital | not published by hospital |
| Michigan | 12 | $1,062.75 | $1,062.75 | $1,062.75 |
| Minnesota | 2 | not published by hospital | not published by hospital | not published by hospital |
| Missouri | 1 | not published by hospital | not published by hospital | not published by hospital |
| New Hampshire | 1 | not published by hospital | not published by hospital | not published by hospital |
| New Jersey | 10 | not published by hospital | not published by hospital | not published by hospital |
| New York | 6 | not published by hospital | not published by hospital | not published by hospital |
| North Carolina | 11 | not published by hospital | not published by hospital | not published by hospital |
| North Dakota | 2 | not published by hospital | not published by hospital | not published by hospital |
| Ohio | 16 | $479.45 | $479.45 | $479.45 |
| South Carolina | 2 | not published by hospital | not published by hospital | not published by hospital |
| South Dakota | 2 | not published by hospital | not published by hospital | not published by hospital |
| Texas | 5 | not published by hospital | not published by hospital | not published by hospital |
| Virginia | 8 | not published by hospital | not published by hospital | not published by hospital |
| Washington | 5 | not published by hospital | not published by hospital | not published by hospital |
| Wisconsin | 3 | $1,600.60 | $1,600.60 | $1,600.60 |
All hospitals
| Hospital | Location | Cash price | Negotiated range |
|---|---|---|---|
| cleveland clinic main campus | Cleveland, OH | $479.45 | $160.80 – $663.86 |
| Henry Ford Hospital | Detroit MI 48202 | 19401 Hubbard Dr., MI | $1,062.75 | $708.50 – $3,048.20 |
| Henry Ford West Bloomfield Hospital | West Bloomfield, MI | $1,062.75 | $708.50 – $1,522.33 |
| Henry Ford Wyandotte Hospital: | Wyandotte, MI | $1,062.75 | $708.50 – $1,532.97 |
| Henry Ford Macomb Hospital | Clinton Twp, MI | $1,062.75 | $708.50 – $1,326.78 |
| Ascension Columbia St. Mary's Hospital - Ozaukee Campus (Columbia St. Mary's Hospital Milwaukee, Inc.) | Mequon, WI | $1,600.60 | $627.77 – $908.02 |
| Ascension Columbia St. Mary's Hospital - Milwaukee Campus (Columbia St. Mary's Hospital Milwaukee, Inc.) | Milwaukee, WI | $1,600.60 | $627.77 – $908.02 |
| Atrium Health Carolinas Medical Center | Charlotte, NC | not published | $656.22 – $804.19 |
| University Hospitals Ahuja Medical Center | Beachwood, OH | not published | $770.11 – $1,386.20 |
| Atrium Health University City | Charlotte, NC | not published | $656.22 – $804.19 |
| Carolinas Rehabilitation Charlotte | Charlotte, NC | not published | $656.22 – $677.51 |
| south pointe hospital | Warrensville Heights, OH | not published | $302.68 – $350.47 |
| mercy hospital | Canton, OH | not published | $271.57 – $298.73 |
| medina hospital | Medina, OH | not published | $266.09 – $308.10 |
| indian river hospital | Vero Beach, FL | not published | $1,188.64 – $1,188.64 |
| HENRICO DOCTORS HOSPITAL | RICHMOND, VA | not published | $611.26 – $769.47 |
| Monmouth Medical Center | Long Branch, NJ | not published | $682.68 – $1,358.53 |
| Jersey City Medical Center | Jersey City, NJ | not published | $416.97 – $1,358.53 |
| Atrium Health Union | Monroe, NC | not published | $656.22 – $804.19 |
| marymount hospital | Garfield Heights, OH | not published | $256.53 – $297.03 |
| martin north hospital | Stuart, FL | not published | $947.91 – $947.91 |
| lodi hospital | Lodi, OH | not published | $443.56 – $513.60 |
| Atrium Health Lincoln | Lincolnton, NC | not published | $656.22 – $804.19 |
| Atrium Health Cabarrus | Concord, NC | not published | $656.22 – $804.19 |
| Atrium Health Cleveland | Shelby, NC | not published | $859.50 – $887.39 |
| hillcrest hospital | Mayfield Heights, OH | not published | $284.32 – $329.21 |
| Atrium Health Stanly | Albermarle, NC | not published | $859.50 – $887.39 |
| lutheran hospital | Cleveland, OH | not published | $259.81 – $300.83 |
| fairview hospital | Cleveland, OH | not published | $272.90 – $315.99 |
| euclid hospital | Euclid, OH | not published | $290.49 – $336.36 |
| cleveland clinic childrens hospital for rehabilitation | Cleveland, OH | not published | $462.92 – $536.01 |
| cleveland clinic florida weston hospital | Weston, FL | not published | $992.05 – $992.05 |
| avon hospital | Avon, OH | not published | $283.53 – $288.93 |
| akron general | Akron, OH | not published | $264.38 – $306.12 |
| Atrium Health Pineville | Charlotte, NC | not published | $656.22 – $804.19 |
| HCA HEALTHCARE BRIGHTON PARK ER | MONCKS CORNER, SC | not published | $636.53 – $1,378.06 |
| Sanford Aberdeen Medical Center | Aberdeen, SD | not published | $800.52 – $884.78 |
| Sanford Fargo Medical Center | Fargo, ND | not published | $675.19 – $746.27 |
| Sanford Medical Center Bismarck | Bismarck, ND | not published | $675.19 – $746.27 |
| Atrium Health Mercy | Charlotte, NC | not published | $656.22 – $804.19 |
| Sanford Worthington Medical Center | Worthington, MN | not published | $700.44 – $884.78 |
| Sanford Bemidji Medical Center | Bemidji, MN | not published | $713.05 – $884.78 |
| HCA HOUSTON NORTHWEST | SPRING, TX | not published | $643.05 – $1,410.77 |
| HCA HOUSTON KINGWOOD | HUMBLE, TX | not published | $643.05 – $1,410.77 |
| TRICITIES HOSPITAL | HOPEWELL, VA | not published | $611.26 – $970.83 |
| STONESPRINGS HOSPITAL CENTER | Dulles, VA | not published | $539.35 – $769.47 |
| SPOTSYLVANIA REGIONAL MEDICAL CENTER | Fredericksburg, VA | not published | $697.56 – $769.47 |
| RESTON HOSPITAL CENTER | VIENNA, VA | not published | $697.56 – $769.47 |
| HCA HOUSTON CONROE | CONROE, TX | not published | $643.05 – $1,410.77 |
| Newark Beth Israel Medical Center | Newark, NJ | not published | $331.68 – $1,358.53 |