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
SIMPLE RPR SUPRFCL WND SCLP/NK/AX/GN/TRK/EXT 2.5CM/LS-CAC
Low
$1
Average
$443
Median
$205
High
$11.7k
Each hospital's average Molina rate, under the methodology and billing class chosen below.
763 hospitals; the 90th percentile is 19.7× the 10th. Each bar is a price range and its height is how many hospitals fall in it. Hover a bar, or a row in the ladder, for details.
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1,194 hospital rates
iThe hospitals that file a Molina rate for this code, one row per hospital and set of terms (billing class, payment method, setting). Rates under different terms are never blended, so the terms are shown under each hospital’s name. Figures are the hospital’s averages across its plans.| # | Plans | |||||||
|---|---|---|---|---|---|---|---|---|
| 1 | ST ELIZABETHS HOSPITAL OF THE HOSPITAL SISTERS OF THE THIRD ORDER OF ST FRANCIS O'Fallon, IL fee schedule · outpatient | 1 | $166 | $166 | — | — | 112 | $166 – $166 |
| 2 | ST JOSEPHS HOSPITAL HOSPITAL SISTERS THIRD ORDER OF ST FRANCIS Carlyle, IL fee schedule · outpatient | 1 | $158 | $158 | — | — | 112 | $158 – $158 |
| 3 | ST JOHNS HOSPITAL OF THE HOSPITAL SISTERS OF THE THIRD ORDER OF ST FRANCIS Springfield, IL fee schedule · outpatient | 1 | $166 | $166 | — | — | 105 | $166 – $166 |
| 4 | St. Joseph Medical Center Bellingham, WA facility · other · outpatient | 2 | $250 | $223 | $47 | 21% | 102–138 | $128 – $250 |
| 5 | PeaceHealth Southwest Medical Center Vancouver, WA facility · other · outpatient | 3 | $134 | $158 | $70 | 44% | 89–152 | $67 – $238 |
| 6 | The Carle Foundation Hospital Urbana, IL percent of total billed charges · outpatientfrom % of charges | 1 | $173 | $173 | — | — | 48 | $173 – $173 |
| 7 | Public Hospital District No 1 of Mason County Shelton, WA fee schedule · both | 1 | $301 | $301 | — | — | 30 | $301 – $301 |
| 8 | Seattle Children's Hospital Seattle, WA professional · fee schedule · both | 2 | $52 | $52 | $26 | 49% | 24 | $27 – $78 |
| 9 | DIGNITY COMMUNITY CARE Northridge, CA fee schedule · outpatient | 2 | $177 | $177 | — | — | 22 | $177 – $177 |
| 10 | DIGNITY HEALTH San Bernardino, CA fee schedule · outpatient | 3 | $179 | $203 | $35 | 17% | 21 | $179 – $252 |
| 11 | PeaceHealth United General Medical Center Sedro Woolley, WA facility · other · outpatient | 1 | $147 | $147 | — | — | 21–30 | $147 – $147 |
| 12 | Carle BroMenn Medical Center Normal, IL percent of total billed charges · outpatientfrom % of charges | 1 | $126 | $126 | — | — | 17 | $126 – $126 |
| 13 | Jackson HMA LLC Jackson, MS facility · other · outpatient | 2 | $158 | $158 | $5 | 3% | 17–26 | $153 – $164 |
| 14 | Brandon HMA LLC Brandon, MS facility · other · outpatient | 2 | $158 | $158 | $5 | 3% | 16–25 | $153 – $164 |
| 15 | Wesley Health System LLC Hattiesburg, MS facility · other · outpatient | 2 | $158 | $158 | $5 | 3% | 16 | $153 – $164 |
| 16 | Las Cruces Medical Center LLC Las Cruces, NM facility · other · outpatient | 1 | $125 | $125 | — | — | 14 | $125 – $125 |
| 17 | Adena Health System Chillicothe, OH facility · other · outpatient | 1 | $89 | $89 | — | — | 13 | $89 – $89 |
| 18 | Self Regional Healthcare Greenwood, SC facility · other · outpatient | 1 | $566 | $566 | — | — | 12 | $566 – $566 |
| 19 | Hshs Good Shepherd Hospital Inc Shelbyville, IL fee schedule · outpatient | 1 | $739 | $739 | — | — | 7–70 | $739 – $739 |
| 20 | Hshs Holy Family Hospital Inc Greenville, IL fee schedule · outpatient | 1 | $166 | $166 | — | — | 7–70 | $166 – $166 |
| 21 | ST ANTHONYS MEMORIAL HOSPITAL OF THE HOSPITAL SISTERS OF THE THIRD ORDER OF ST FRANCIS Effingham, IL fee schedule · outpatient | 1 | $166 | $166 | — | — | 7–70 | $166 – $166 |
| 22 | ST FRANCIS HOSPITAL SISTERS OF THE THIRD ORDER OF ST FRANCIS Litchfield, IL fee schedule · outpatient | 1 | $238 | $238 | — | — | 7–70 | $238 – $238 |
| 23 | ST JOSEPHS HOSPITAL OF THE HOSPITAL SISTERS OF THE THIRD ORDER OF ST FRANCIS HIGHLAND, IL fee schedule · outpatient | 1 | $368 | $368 | — | — | 7–70 | $368 – $368 |
| 24 | ST MARYS HOSPITAL DECATUR OF HOSPITAL SISTERS OF THE THIRD ORDER OF ST FRANCIS Chatham, IL fee schedule · outpatient | 1 | $166 | $166 | — | — | 7–70 | $166 – $166 |
| 25 | Columbus Regional Healthcare System, Inc Whiteville, NC percent of total billed charges · outpatientfrom % of charges | 1 | $93 | $93 | — | — | 3–30 | $93 – $93 |
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