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
HB Trluml Dilat Aqueous O/F Can WO Retention Dev/St
Low
$80
Average
$2.5k
Median
$2.3k
High
$12.6k
Each hospital's average Medicaid rate, under the methodology and billing class chosen below.
32 hospitals; the 90th percentile is 34.3× 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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34 hospital rates
iThe hospitals that file a Medicaid 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 | ACADIAN MEDICAL CENTER EUNICE, LA fee schedule · both | 3 | $683 | $683 | — | — | — | $683 – $683 |
| 2 | ACADIAN MEDICAL CENTER EUNICE, LA percent of total billed charges · bothfrom % of charges | 6 | $5.7k | $5.7k | $3.9k | 68% | — | $1.8k – $9.5k |
| 3 | ADVENTIST HEALTH MEDICAL CENTER TEHACHAPI Tehachapi, CA fee schedule · outpatient | 1 | $170 | $170 | — | — | — | $170 – $170 |
| 4 | ADVENTIST HEALTH MENDOCINO COAST Bragg, CA fee schedule · outpatient | 1 | $500 | $500 | — | — | — | $500 – $500 |
| 5 | ADVENTIST HEALTH TULARE Tulare, CA fee schedule · outpatient | 1 | $135 | $135 | — | — | — | $135 – $135 |
| 6 | CATHOLIC HEALTH INITIATIVES COLORADO Salt Lake City, UT fee schedule · outpatient | 1 | $490 | $490 | — | — | — | $490 – $490 |
| 7 | Cleveland Clinic Weston Hospital Nonprofit Corporation Weston, FL facility · case rate · outpatient | 1 | $2.2k | $2.2k | — | — | — | $2.2k – $2.2k |
| 8 | FRANCISCAN ALLIANCE, INC. dba FRANCISCAN HEALTH CRAWFORDSVILLE CRAWFORDSVILLE, IN fee schedule · outpatient | 1 | $4.3k | $4.3k | — | — | — | $4.3k – $4.3k |
| 9 | FRANCISCAN ALLIANCE, INC. dba FRANCISCAN HEALTH CROWN POINT CROWN POINT, IN fee schedule · outpatient | 1 | $4.3k | $4.3k | — | — | — | $4.3k – $4.3k |
| 10 | FRANCISCAN ALLIANCE, INC. dba FRANCISCAN HEALTH DYER DYER, IN fee schedule · outpatient | 2 | $4.7k | $4.7k | $432 | 9% | — | $4.3k – $5.2k |
| 11 | FRANCISCAN ALLIANCE, INC. dba FRANCISCAN HEALTH MUNSTER MUNSTER, IN fee schedule · outpatient | 2 | $4.7k | $4.7k | $432 | 9% | — | $4.3k – $5.2k |
| 12 | Fairview Maple Grove Surgery Center Maple Grove, MN fee schedule · both | 1 | $432 | $432 | — | — | — | $432 – $432 |
| 13 | Fairview Maple Grove Surgery Center Maple Grove, MN fee schedule · outpatient | 1 | $2.1k | $2.1k | — | — | — | $2.1k – $2.1k |
| 14 | Granbury Hospital Corporation Granbury, TX facility · fee schedule · outpatient | 1 | $5.4k | $5.4k | — | — | — | $5.4k – $5.4k |
| 15 | HANFORD COMMUNITY HOSPITAL Selma, CA fee schedule · outpatient | 1 | $80 | $80 | — | — | — | $80 – $80 |
| 16 | INDIAN RIVER MEMORIAL HOSPITAL INC Vero Beach, FL facility · case rate · outpatient | 1 | $2.2k | $2.2k | — | — | — | $2.2k – $2.2k |
| 17 | LODI MEMORIAL HOSPITAL ASSOCIATION INC Lodi, CA fee schedule · outpatient | 1 | $500 | $500 | — | — | — | $500 – $500 |
| 18 | Longview Medical Center LP Longview, TX facility · fee schedule · outpatient | 1 | $1.4k | $1.4k | — | — | — | $1.4k – $1.4k |
| 19 | Mercy Hospital Lebanon dba Mercy Hospital Lebanon Rolla, MO facility · fee schedule · outpatient | 2 | $3.5k | $3.5k | $77 | 2% | — | $3.4k – $3.6k |
| 20 | Mercy Hospital Springfield Ozark, MO facility · fee schedule · outpatient | 3 | $3.4k | $2.5k | $1.5k | 60% | — | $363 – $3.6k |
| 21 | Mercy Hospital Springfield Springfield, MO facility · fee schedule · outpatient | 3 | $3.4k | $2.5k | $1.5k | 60% | — | $363 – $3.6k |
| 22 | NYU Langone New York, NY case rate · both | 15 | $2.9k | $2.9k | — | — | — | $2.9k – $2.9k |
| 23 | NYU Langone Mineola, NY case rate · both | 15 | $2.9k | $2.9k | — | — | — | $2.9k – $2.9k |
| 24 | NYU Langone Brooklyn, NY case rate · both | 15 | $2.9k | $2.9k | — | — | — | $2.9k – $2.9k |
| 25 | NYU Langone New York, NY case rate · both | 15 | $2.9k | $2.9k | — | — | — | $2.9k – $2.9k |
← Payers reporting CPT 66174 · Snapshot 20261111T120946Z-9134e7f7