Ear irrigation cost in Pennsylvania
In Pennsylvania, 91 hospitals publish a cash price for earwax removal by irrigation (rinsing), one ear: from $14.40 to $1,399.99, with a median of $139.80. The lowest price is at Meadville Medical Center (Meadville). The highest price is 97.2× the lowest.
- The median here, $139.80, is 32% above the US median of $105.95.
- That is 2.3× Medicare's 2026 national rate for the same service ($60.27).
- Pennsylvania ranks 37th of 49 states by median, cheapest first.
- 9 of 91 hospitals list a cash price equal to their full list price, with no self-pay discount.
Outpatient cash prices, one line per hospital — its lowest listed price for code 69209. Prices for both sides of the body and inpatient prices are not mixed in. Collected Nov 11, 2026. See them on a map
Lowest$14.40Meadville Medical Center
Median$139.80half of hospitals charge less
Highest$1,399.99in Pennsylvania
Lowest saves$125.40vs the median
Hospitals in Pennsylvania, cheapest first
| Hospital | Cash price | List price | File date |
|---|---|---|---|
| Meadville Medical Center lowest Meadville · Meadville, PA REMOVE IMPACTED EAR WAX UNI | $14.40 | $24.00 | Sep 11, 2026 source file |
| Penn Highlands Brookville Brookville · Brookville, PA Q-CARE REMOVE IMPACTED EAR WAX IRR/LAVAGE UNI | $15.00 | $15.00 | Apr 1, 2026 source file |
| Penn Highlands Clearfield Clearfield · DuBois, PA Q-CARE REMOVE IMPACTED EAR WAX IRR/LAVAGE UNI | $15.00 | $15.00 | Apr 1, 2026 source file |
| Penn Highlands Dubois DuBois · DuBois, PA Q-CARE REMOVE IMPACTED EAR WAX IRR/LAVAGE UNI | $15.00 | $15.00 | Apr 1, 2026 source file |
| Penn Highlands Elk Saint Marys · St. Marys, PA Q-CARE REMOVE IMPACTED EAR WAX IRR/LAVAGE UNI | $15.00 | $15.00 | Apr 1, 2026 source file |
| Penn Highlands Huntingdon Huntingdon · Huntingdon, PA Q-CARE REMOVE IMPACTED EAR WAX IRR/LAVAGE UNI | $15.00 | $15.00 | Apr 1, 2026 source file |
| Penn Highlands Tyrone Tyrone · Altoona, PA Q-CARE REMOVE IMPACTED EAR WAX IRR/LAVAGE UNI | $15.00 | $15.00 | Apr 1, 2026 source file |
| Lankenau Medical Center one side Wynnewood · Philadelphia-Camden-Wilmington, PA-NJ-DE-MD Hc Removal Impacted Cerumen Irrigation/Lvg Unilat | $22.00 | $55.00 | Apr 1, 2026 source file |
| Paoli Hospital one side Paoli · Philadelphia-Camden-Wilmington, PA-NJ-DE-MD Hc Removal Impacted Cerumen Irrigation/Lvg Unilat | $22.00 | $55.00 | Apr 1, 2026 source file |
| Riddle Memorial Hospital one side Media · Philadelphia-Camden-Wilmington, PA-NJ-DE-MD Hc Removal Impacted Cerumen Irrigation/Lvg Unilat | $22.00 | $55.00 | Apr 1, 2026 source file |
| The Bryn Mawr Hospital one side Bryn Mawr · Philadelphia-Camden-Wilmington, PA-NJ-DE-MD Hc Removal Impacted Cerumen Irrigation/Lvg Unilat | $22.00 | $55.00 | Apr 1, 2026 source file |
| Robert Packer Hospital Sayre · Sayre, PA Rmve Impcted Cerumen Irrig/Lavage | $31.75 | $39.69 | Mar 31, 2026 source file |
| Robert Packer Hospital, Towanda Campus Towanda · Sayre, PA Rmve Impcted Cerumen Irrig/Lavage | $31.75 | $39.69 | Mar 31, 2026 source file |
| Troy Community Hospital Troy · Sayre, PA Rmve Impcted Cerumen Irrig/Lavage | $31.75 | $39.69 | Mar 31, 2026 source file |
| UPMC Kane Kane · Bradford, PA RMVL IMPACTED CERUMEN W/IRRIGATION UNILA | $41.40 | $69.00 | Mar 6, 2026 source file |
| Armstrong County Memorial Hospital Kittanning · Pittsburgh, PA REM CERUMEN W/IRRIGATION, UNI | $51.90 | $173.00 | Mar 2, 2026 source file |
| Lower Bucks Hospital Bristol · Philadelphia-Camden-Wilmington, PA-NJ-DE-MD Hc Remove Impacted Ear Wax Uni | $58.00 | $245.84 | Sep 1, 2026 source file |
| Roxborough Memorial Hospital Philadelphia · Philadelphia-Camden-Wilmington, PA-NJ-DE-MD Hc Remove Impacted Ear Wax Uni | $60.00 | $289.87 | Sep 1, 2026 source file |
| Uniontown Hospital Uniontown · Pittsburgh, PA REMOVE IMPACTED EAR WAX UNI | $68.00 | $136.00 | Jul 9, 2026 source file |
| UPMC Bedford Everett · Everett, PA RMV IMPACT CERUMEN IRR/LAV | $75.60 | $126.00 | Sep 18, 2026 source file |
| UPMC East Monroeville · Pittsburgh, PA RMV IMPACT CERUMEN IRR/LAV | $76.80 | $128.00 | Mar 6, 2026 source file |
| Indiana Regional Medical Center Indiana · Indiana, PA Ear Irrigation POC 69209 | $77.76 | $216.00 | Feb 24, 2026 source file |
| Excela Health - Frick Hospital Mt Plesant · Pittsburgh, PA REM CERUMEN, LAV UNI | $78.00 | $130.00 | Dec 17, 2025 source file |
| Excela Health Latrobe Hospital Latrobe · Pittsburgh, PA REM CERUMEN, LAV UNI | $78.00 | $130.00 | Dec 17, 2025 source file |
| Excela Health Westmoreland Regional Hospital Greeensburg · Pittsburgh, PA REM CERUMEN, LAV UNI | $78.00 | $130.00 | Dec 17, 2025 source file |
| UPMC Northwest Seneca · Oil City, PA RMV IMPACT CERUMEN IRR/LAV | $79.80 | $133.00 | Mar 6, 2026 source file |
| Conemaugh Memorial Medical Center one side Johnstown · Johnstown, PA Removal impacted cerumen using irrigation/lavage, unilateral | $80.80 | $202.00 | Apr 15, 2026 source file |
| Millcreek Medical Center Erie · Erie, PA REMVL IMPCTD CERUMEN W/LAVAGE | $86.00 | $172.00 | May 8, 2026 source file |
| Punxsutawney Area Hospital Punxsutawney · Punxsutawney, PA CERUMEN REMOVAL W/IRR UNI TC | $86.40 | $240.00 | Mar 2, 2026 source file |
| Penn State Health Holy Spirit Medical Center Camp Hill · Harrisburg-Carlisle, PA 69209 REMOVE IMPACTED EAR WAX UNI Tech | $92.22 | $386.00 | Mar 27, 2026 source file |
| St Joseph Regional Health Network Reading · Reading, PA REMOVE IMPACTED EAR WAX | $100.40 | $386.00 | Mar 27, 2026 source file |
| Penn State Health Lancaster Medical Center Lancaster · Lancaster, PA 69209 REMOVE IMPACTED EAR WAX UNI Tech | $111.90 | $386.00 | Mar 27, 2026 source file |
| Mount Nittany Health State College · State College, PA REMOVE IMPACTED EAR WAX UNI | $112.05 | $249.00 | Jan 1, 2026 source file |
| Gettysburg Hospital Gettysburg · Gettysburg, PA Removal of Impacted Ear Wax by Washing | $114.40 | $143.00 | Jan 1, 2026 source file |
| York Hospital York · York-Hanover, PA Removal of Impacted Ear Wax by Washing | $114.40 | $143.00 | Jan 1, 2026 source file |
| UPMC Muncy Muncy · Williamsport, PA RMV IMPACT CERUMEN IRR/LAV | $117.00 | $195.00 | Mar 6, 2026 source file |
| UPMC Wellsboro Wellsboro · Wellsboro, PA RMV IMPACT CERUMEN IRR/LAV | $117.00 | $195.00 | Mar 6, 2026 source file |
| UPMC Williamsport Williamsport · Williamsport, PA RMV IMPACT CERUMEN IRR/LAV | $117.00 | $195.00 | Mar 6, 2026 source file |
| UPMC McKeesport McKeesport · Pittsburgh, PA RMV IMPACT CERUMEN IRR/LAV | $119.40 | $199.00 | Mar 6, 2026 source file |
| UPMC Altoona Altoona · Altoona, PA RMV IMPACT CERUMEN IRR/LAV | $120.00 | $200.00 | Mar 6, 2026 source file |
| Penn State Health Hampden Medical Center Enola · Harrisburg-Carlisle, PA 69209 REMOVE IMPACTED EAR WAX UNI Tech | $121.47 | $386.00 | Mar 27, 2026 source file |
| Wayne Memorial Hospital Honesdale · Honesdale, PA REMOVE EAR WAX IRRIGATE | $123.20 | $176.00 | Sep 16, 2026 source file |
| Penn State Health Milton S. Hershey Medical Center one side Hershey · Harrisburg-Carlisle, PA 69209 Remove Impact Cerumen Irrig/Lavage; Unilat | $127.88 | $386.00 | Mar 27, 2026 source file |
| UPMC Childrens Hospital of Pittsburgh Pittsburgh · Pittsburgh, PA RMV IMPACT CERUMEN IRR/LAV | $131.40 | $219.00 | Mar 6, 2026 source file |
| UPMC Passavant - McCandless Pittsburgh · Pittsburgh, PA HC REM IMPACTED CERUMEN VIA IRRIG UNI | $137.40 | $229.00 | Mar 7, 2026 source file |
| UPMC Hamot Erie · Erie, PA RMV IMPACT CERUMEN IRR/LAV | $139.80 | $233.00 | Mar 6, 2026 source file |
| UPMC St Margaret Pittsburgh · Pittsburgh, PA RMV IMPACT CERUMEN IRR/LAV | $149.40 | $249.00 | Mar 6, 2026 source file |
| Allegheny Valley Hospital Natrona Heights · Pittsburgh, PA HC REM CERUMEN IRRIG/LAVAGE BIL | $164.78 | $214.00 | Oct 28, 2026 source file |
| Warren General Hospital Warren · Warren, PA REM IMPACTED EAR WAX UNI-MCR | $165.00 | $165.00 | Sep 24, 2026 source file |
| UPMC Magee-Womens Hospital Pittsburgh · Pittsburgh, PA HC REM IMPACTED CERUMEN VIA IRRIG UNI | $166.20 | $277.00 | Mar 6, 2026 source file |
| Canonsburg General Hospital Canonsburg · Pittsburgh, PA HC REM CERUMEN IRRIG/LAVAGE BIL | $166.92 | $214.00 | Oct 28, 2026 source file |
| Forbes Hospital Monroeville · Pittsburgh, PA HC REM CERUMEN IRRIG/LAVAGE UNI | $166.92 | $214.00 | Oct 28, 2026 source file |
| AHN Wexford Hospital Wexford · Pittsburgh, PA HC REM CERUMEN IRRIG/LAVAGE BIL | $167.24 | $226.00 | Oct 28, 2026 source file |
| UPMC Mercy Pittsburgh · Pittsburgh, PA RMV IMPACT CERUMEN IRR/LAV | $168.00 | $280.00 | Mar 6, 2026 source file |
| UPMC Presbyterian Pittsburgh · Pittsburgh, PA RMV IMPACT CERUMEN IRR/LAV | $169.20 | $282.00 | Mar 6, 2026 source file |
| West Penn Hospital Pittsburgh · Pittsburgh, PA HC REM CERUMEN IRRIG/LAVAGE UNI | $173.74 | $238.00 | Oct 28, 2026 source file |
| Grove City Medical Center Grove City · Hermitage, PA HC REM CERUMEN IRRIG/LAVAGE UNI | $174.02 | $226.00 | Oct 28, 2026 source file |
| Allegheny General Hospital Pittsburgh · Pittsburgh, PA HC REM CERUMEN IRRIG/LAVAGE UNI | $180.88 | $238.00 | Oct 28, 2026 source file |
| Jefferson Regional Medical Center Jefferson Hills · Pittsburgh, PA HC REM CERUMEN IRRIG/LAVAGE BIL | $183.06 | $226.00 | Oct 28, 2026 source file |
| Sharon Regional Medical Center one side Sharon · Hermitage, PA REMOVE IMPACTD EAR WAX UNI LT | $184.71 | $184.71 | Jul 4, 2024 source file |
| UPMC Horizon - Greenville Greenville · Hermitage, PA RMV IMPACT CERUMEN IRR/LAV | $192.60 | $321.00 | Mar 6, 2026 source file |
| UPMC Jameson New Castle · Pittsburgh, PA RMV IMPACT CERUMEN IRR/LAV | $192.60 | $321.00 | Mar 6, 2026 source file |
| St Luke's Hospital - Allentown Campus Allentown · Allentown-Bethlehem-Easton, PA-NJ HB REMOVE IMPACTED EAR WAX UNI (IRRIGATION/LAVAGE) | $209.99 | $253.00 | Feb 26, 2026 source file |
| St Luke's Hospital - Anderson Campus Easton · Allentown-Bethlehem-Easton, PA-NJ HB REMOVE IMPACTED EAR WAX UNI (IRRIGATION/LAVAGE) | $209.99 | $253.00 | Feb 26, 2026 source file |
| St Luke's Hospital - Bethlehem Campus Bethlehem · Allentown-Bethlehem-Easton, PA-NJ HB REMOVE IMPACTED EAR WAX UNI (IRRIGATION/LAVAGE) | $209.99 | $253.00 | Feb 26, 2026 source file |
| St Luke's Hospital - Carbon Campus Lehighton · Allentown-Bethlehem-Easton, PA-NJ HB REMOVE IMPACTED EAR WAX UNI (IRRIGATION/LAVAGE) | $209.99 | $253.00 | Feb 27, 2026 source file |
| St Luke's Hospital - Easton Campus Easton · Allentown-Bethlehem-Easton, PA-NJ HB REMOVE IMPACTED EAR WAX UNI (IRRIGATION/LAVAGE) | $209.99 | $253.00 | Feb 26, 2026 source file |
| St Luke's Hospital - Lehighton Campus Lehighton · Allentown-Bethlehem-Easton, PA-NJ HB REMOVE IMPACTED EAR WAX UNI (IRRIGATION/LAVAGE) | $209.99 | $253.00 | Feb 27, 2026 source file |
| St Luke's Hospital - Monroe Campus Stroudsburg · East Stroudsburg, PA HB REMOVE IMPACTED EAR WAX UNI (IRRIGATION/LAVAGE) | $209.99 | $253.00 | Feb 27, 2026 source file |
| St Luke's Hospital - Sacred Heart Campus Allentown · Allentown-Bethlehem-Easton, PA-NJ HB REMOVE IMPACTED EAR WAX UNI (IRRIGATION/LAVAGE) | $209.99 | $253.00 | Feb 26, 2026 source file |
| Evangelical Community Hospital Lewisburg · Lewisburg, PA Removal of Impacted Ear Wax by Washing | $210.20 | $262.75 | Jan 1, 2026 source file |
| UPMC Carlisle one side Carlisle · Harrisburg-Carlisle, PA HC RMVL IMPCTD CERUMEN USING IRRIG/LAVG, UNILAT | $214.80 | $358.00 | Mar 6, 2026 source file |
| UPMC Hanover one side Hanover · York-Hanover, PA HC RMVL IMPCTD CERUMEN USING IRRIG/LAVG, UNILAT | $214.80 | $358.00 | Mar 6, 2026 source file |
| UPMC Lititz one side Lititz · Lancaster, PA HC RMVL IMPCTD CERUMEN USING IRRIG/LAVG, UNILAT | $214.80 | $358.00 | Mar 6, 2026 source file |
| UPMC Memorial one side York · York-Hanover, PA HC RMVL IMPCTD CERUMEN USING IRRIG/LAVG, UNILAT | $214.80 | $358.00 | Oct 28, 2026 source file |
| UPMC Pinnacle Hospitals one side Harrisburg · Harrisburg-Carlisle, PA HC RMVL IMPCTD CERUMEN USING IRRIG/LAVG, UNILAT | $214.80 | $358.00 | Mar 6, 2026 source file |
| UPMC Somerset one side Somerset · Somerset, PA HC RMVL IMPCTD CERUMEN USING IRRIG/LAVG, UNILAT | $214.80 | $358.00 | Mar 6, 2026 source file |
| Chambersburg Hospital Chambersburg · Chambersburg, PA Removal of Impacted Ear Wax by Washing | $225.60 | $282.00 | Jan 1, 2026 source file |
| Ephrata Community Hospital Ephrata · Lancaster, PA Removal of Impacted Ear Wax by Washing | $225.60 | $282.00 | Jan 1, 2026 source file |
| Waynesboro Hospital Waynesboro · Chambersburg, PA Removal of Impacted Ear Wax by Washing | $225.60 | $282.00 | Jan 1, 2026 source file |
| St Mary Medical Center one side Langhorne · Philadelphia-Camden-Wilmington, PA-NJ-DE-MD HC Removal Ceremun Impacted Irrigation Rt | $243.75 | $375.00 | Mar 31, 2026 source file |
| St Luke's Hospital - Grand View Campus Sellersville · Philadelphia-Camden-Wilmington, PA-NJ-DE-MD HB REMOVE IMPACTED EAR WAX UNI (IRRIGATION/LAVAGE) | $246.60 | $274.00 | Feb 26, 2026 source file |
| St Luke's Hospital - Upper Bucks Campus Quakertown · Philadelphia-Camden-Wilmington, PA-NJ-DE-MD HB REMOVE IMPACTED EAR WAX UNI (IRRIGATION/LAVAGE) | $246.60 | $274.00 | Feb 26, 2026 source file |
| Good Samaritan Hospital Lebanon · Lebanon, PA Removal of Impacted Ear Wax by Washing | $277.60 | $347.00 | Jan 1, 2026 source file |
| Shriners Childrens - Philadelphia Philadelphia · Philadelphia-Camden-Wilmington, PA-NJ-DE-MD REMOVE IMPACTED EAR WAX UNI | $313.19 | $313.19 | Mar 19, 2026 source file |
| Geisinger Community Medical Center Scranton · Scranton--Wilkes-Barre, PA HC RMV IMPACTED EAR WAX W/LAV UNI (ED) | $377.50 | $755.00 | Jul 1, 2026 source file |
| Highlands Hospital one side Connellsville · Pittsburgh, PA CERUMEN REMOVAL UNILATERAL W/IRRIGATION | $431.40 | $719.00 | Feb 2, 2026 source file |
| Wilkes-Barre General Hospital Wilkes-Barre · Scranton--Wilkes-Barre, PA REMOVE IMPACTED EAR WAX UNI | $833.76 | $3,474.00 | Dec 1, 2024 source file |
| Moses Taylor Hospital Scranton · Scranton--Wilkes-Barre, PA REMOVE IMPACTED EAR WAX UNI | $1,353.24 | $5,012.00 | Dec 2, 2024 source file |
| Regional Hospital of Scranton Scranton · Scranton--Wilkes-Barre, PA REMOVE IMPACTED EAR WAX UNI | $1,353.24 | $5,012.00 | Dec 2, 2024 source file |
| Holy Redeemer Hospital and Medical Center Meadowbrook · Philadelphia-Camden-Wilmington, PA-NJ-DE-MD Remove Impacted Ear Wax Uni - ER | $1,399.99 | $2,333.31 | Sep 21, 2026 source file |
Hospital The hospital that published the price, its city and the line exactly as written in its price file.
Cash price The hospital's own price for a patient paying without insurance (“discounted cash” in its price file). Hospitals must publish it under federal law, 45 CFR 180.50. Call to confirm it before booking. More
List price The hospital's full chargemaster price (“gross charge”) before any discount. Almost nobody pays it; the gap to the cash price shows what the self-pay discount is worth. More
File date When the hospital last updated its price file, as the file says itself. A dash means the file gives no date.
At or below Medicare This cash price is at or below what Medicare pays a hospital for the same service, which is unusually low. It is what the hospital's file says; confirm it and what it includes before booking. More
No cash discount This line's cash price equals the hospital's full list price. Many hospitals still reduce bills for uninsured patients: ask the billing office for its self-pay discount in writing. More
By metro area
Each metro page compares every listing, including prices for both sides of the body.
| Metro area | Hospitals | Lowest | Median |
|---|---|---|---|
| Pittsburgh, PA | 22 | $51.90 | $165.49 |
| Philadelphia-Camden-Wilmington, PA-NJ-DE-MD | 11 | $22.00 | $60.00 |
| Allentown-Bethlehem-Easton, PA-NJ | 7 | $209.99 | $209.99 |
| Harrisburg-Carlisle, PA | 5 | $92.22 | $127.88 |
| Scranton--Wilkes-Barre, PA | 4 | $377.50 | $1,093.50 |
| Hermitage, PA | 3 | $174.02 | $184.71 |
| Lancaster, PA | 3 | $111.90 | $214.80 |
| Sayre, PA | 3 | $31.75 | $31.75 |
| York-Hanover, PA | 3 | $114.40 | $214.80 |
| Altoona, PA | 2 | $15.00 | $67.50 |
| Chambersburg, PA | 2 | $225.60 | $225.60 |
| DuBois, PA | 2 | $15.00 | $15.00 |
| Erie, PA | 2 | $86.00 | $112.90 |
| Williamsport, PA | 2 | $117.00 | $117.00 |
| Brookville, PA | 1 | $15.00 | $15.00 |
| Bradford, PA | 1 | $41.40 | $41.40 |
| Everett, PA | 1 | $75.60 | $75.60 |
| East Stroudsburg, PA | 1 | $209.99 | $209.99 |
| Gettysburg, PA | 1 | $114.40 | $114.40 |
| Honesdale, PA | 1 | $123.20 | $123.20 |
| Huntingdon, PA | 1 | $15.00 | $15.00 |
| Indiana, PA | 1 | $77.76 | $77.76 |
| Johnstown, PA | 1 | $80.80 | $80.80 |
| Lebanon, PA | 1 | $277.60 | $277.60 |
| Lewisburg, PA | 1 | $210.20 | $210.20 |
| Meadville, PA | 1 | $14.40 | $14.40 |
| Oil City, PA | 1 | $79.80 | $79.80 |
| Punxsutawney, PA | 1 | $86.40 | $86.40 |
| Reading, PA | 1 | $100.40 | $100.40 |
| Somerset, PA | 1 | $214.80 | $214.80 |
| St. Marys, PA | 1 | $15.00 | $15.00 |
| State College, PA | 1 | $112.05 | $112.05 |
| Wellsboro, PA | 1 | $117.00 | $117.00 |
| Warren, PA | 1 | $165.00 | $165.00 |
Market A metro area (as the Census Bureau defines it) or, outside metro areas, a town. Each links to every hospital price there.
Hospitals How many hospitals publish a cash price for this code here. Each hospital counts once, at its lowest outpatient cash price.
Lowest The lowest cash price among those hospitals.
Median The middle cash price: half of the hospitals charge less, half charge more. One price per hospital. More
What ear irrigation is, what the price covers and why prices differ: Ear irrigation explained.
Earwax removal by irrigation (rinsing), one ear in other states
- Alabama$99.59
- Alaska$91.26
- Arizona$440.63
- Arkansas$54.00
- California$177.52
- Colorado$122.01
- Connecticut$115.80
- Delaware$246.96
- District of Columbia$187.73, 3 hospitals
- Florida$188.65
- Georgia$102.60
- Hawaii$219.80
- Idaho$111.80
- Illinois$115.44
- Indiana$175.80
- Iowa$69.19
- Kansas$97.16
- Kentucky$104.70
- Louisiana$76.59
- Maine$51.10
- Maryland$35.54, 2 hospitals
- Massachusetts$208.00
- Michigan$101.90
- Minnesota$77.42
- Mississippi$56.80
- Missouri$110.50
- Montana$43.90
- Nebraska$63.38
- Nevada$84.50
- New Hampshire$71.82
- New Jersey$372.02
- New Mexico$132.60
- New York$121.00
- North Carolina$106.20
- North Dakota$60.80
- Ohio$154.70
- Oklahoma$61.80
- Oregon$77.73
- Puerto Rico$50.50, 2 hospitals
- Rhode Island$179.83
- South Carolina$117.50
- South Dakota$163.60
- Tennessee$45.30
- Texas$111.30
- Utah$164.64
- Vermont$99.50
- Virginia$97.50
- Washington$111.36
- West Virginia$84.25
- Wisconsin$88.31
- Wyoming$91.00
Median cash price across the state's hospitals.