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
HC TBS TECHNICAL CALCULATION ONLY
Low
$1
Average
$66
Median
$49
High
$220
Each hospital's average Medicaid rate, under the methodology and billing class chosen below.
40 hospitals; the 90th percentile is 183.2× 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.
Filter by billing methodology
Filter by billing class
44 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 | Hospital Service District #1, Parish of Terrebonne, State of Louisiana dba Terrebonne General Health System Houma, LA facility · other · outpatient | 1 | $42 | $42 | — | — | 1–10 | $42 – $42 |
| 2 | ARTHUR G JAMES CANCER HOSPITAL AND RESEARCH INSTITUTE Columbus, OH percent of total billed charges · inpatientfrom % of charges | 1 | $145 | $145 | — | — | — | $145 – $145 |
| 3 | ARTHUR G JAMES CANCER HOSPITAL AND RESEARCH INSTITUTE Columbus, OH percent of total billed charges · outpatientfrom % of charges | 1 | $117 | $117 | — | — | — | $117 – $117 |
| 4 | BAPTIST HOSPITAL OF MIAMI PLANTATION, FL fee schedule · both | 2 | $50 | $50 | $2 | 5% | — | $48 – $53 |
| 5 | BETHESDA HOSPITAL BOYNTON BEACH, FL fee schedule · both | 2 | $50 | $50 | $2 | 5% | — | $48 – $53 |
| 6 | Berkshire Medical Center Great Barrington, MA professional · fee schedule · outpatient | 2 | $22 | $22 | — | — | — | $22 – $22 |
| 7 | CATHOLIC HEALTH INITIATIVES COLORADO Salt Lake City, UT fee schedule · outpatient | 1 | $21 | $21 | — | — | — | $21 – $21 |
| 8 | Cleveland Clinic Weston Hospital Nonprofit Corporation Weston, FL facility · case rate · outpatient | 1 | $47 | $47 | — | — | — | $47 – $47 |
| 9 | DOCTORS HOSPITAL CORAL GABLES, FL fee schedule · both | 2 | $49 | $49 | $2 | 5% | — | $46 – $51 |
| 10 | FISHERMENS HEALTH, INC MARATHON, FL fee schedule · both | 2 | $49 | $49 | $2 | 5% | — | $46 – $51 |
| 11 | Fairview Hospital Great Barrington, MA professional · fee schedule · outpatient | 2 | $22 | $22 | — | — | — | $22 – $22 |
| 12 | Fairview Maple Grove Surgery Center Maple Grove, MN fee schedule · both | 1 | $20 | $20 | — | — | — | $20 – $20 |
| 13 | Geisinger Bloomsburg Hospital Bloomsburg, PA fee schedule · outpatient | 1 | $1 | $1 | — | — | — | $1 – $1 |
| 14 | Geisinger Community Medical Center Scranton, PA fee schedule · outpatient | 1 | $1 | $1 | — | — | — | $1 – $1 |
| 15 | Geisinger Jersey Shore Hospital Jersey Shore, PA fee schedule · outpatient | 1 | $1 | $1 | — | — | — | $1 – $1 |
| 16 | Geisinger Lewistown Hospital Lewistown, PA fee schedule · outpatient | 1 | $1 | $1 | — | — | — | $1 – $1 |
| 17 | Geisinger Medical Center Muncy, PA fee schedule · outpatient | 1 | $1 | $1 | — | — | — | $1 – $1 |
| 18 | Geisinger Wyoming Valley Wilkes-Barre, PA fee schedule · outpatient | 1 | $1 | $1 | — | — | — | $1 – $1 |
| 19 | HOMESTEAD HOSPITAL Homestead, FL fee schedule · both | 2 | $49 | $49 | $2 | 5% | — | $46 – $51 |
| 20 | HealthAlliance - Clinton Hospital MA 01453; 201 Highland St Clinton, MA other · both | 1 | $106 | $106 | — | — | — | $106 – $106 |
| 21 | HealthAlliance - Clinton Hospital MA 01453; 201 Highland St Clinton, MA percent of total billed charges · bothfrom % of charges | 1 | $161 | $161 | — | — | — | $161 – $161 |
| 22 | Henry Ford Health Novi, MI other · outpatient | 1 | $50 | $50 | — | — | — | $50 – $50 |
| 23 | Henry Ford Health Twp, MI other · outpatient | 1 | $51 | $51 | — | — | — | $51 – $51 |
| 24 | Henry Ford Health Southfield, MI other · outpatient | 1 | $50 | $50 | — | — | — | $50 – $50 |
| 25 | Henry Ford Health Rochester, MI other · outpatient | 1 | $47 | $47 | — | — | — | $47 – $47 |
← Payers reporting CPT 77091 · Snapshot 20261111T120946Z-9134e7f7