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
PRO FEE RT TX PLAN; INTERMED
Low
$70
Average
$127
Median
$93
High
$386
Each hospital's average Medicaid rate, under the methodology and billing class chosen below.
29 hospitals; the 90th percentile is 3.1× 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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33 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 | ADVENTIST HEALTH MEDICAL CENTER TEHACHAPI Tehachapi, CA fee schedule · outpatient | 1 | $93 | $93 | — | — | — | $93 – $93 |
| 2 | ADVENTIST HEALTH MENDOCINO COAST Bragg, CA fee schedule · outpatient | 1 | $93 | $93 | — | — | — | $93 – $93 |
| 3 | ADVENTIST HEALTH TULARE Tulare, CA fee schedule · outpatient | 1 | $93 | $93 | — | — | — | $93 – $93 |
| 4 | Butler Healthcare Providers_ DBA Butler Memorial Hospital Butler, PA facility · fee schedule · outpatient | 1 | $100 | $100 | — | — | — | $100 – $100 |
| 5 | CATHOLIC HEALTH INITIATIVES COLORADO Salt Lake City, UT fee schedule · outpatient | 1 | $88 | $88 | — | — | — | $88 – $88 |
| 6 | Clarion Hospital Clarion, PA facility · fee schedule · outpatient | 1 | $100 | $100 | — | — | — | $100 – $100 |
| 7 | Cleveland Clinic Weston Hospital Nonprofit Corporation Weston, FL facility · case rate · outpatient | 1 | $75 | $75 | — | — | — | $75 – $75 |
| 8 | Covenant Medical Center Inc Waterloo, IA professional · fee schedule · inpatient | 1 | $104 | $104 | — | — | — | $104 – $104 |
| 9 | Covenant Medical Center Inc Waterloo, IA professional · fee schedule · outpatient | 1 | $104 | $104 | — | — | — | $104 – $104 |
| 10 | Eisenhower Medical Center Rancho Mirage, CA fee schedule · both | 3 | $133 | $133 | — | — | — | $133 – $133 |
| 11 | Fairview Maple Grove Surgery Center Maple Grove, MN fee schedule · both | 1 | $75 | $75 | — | — | — | $75 – $75 |
| 12 | GLENDALE ADVENTIST MEDICAL CENTER Glendale, CA fee schedule · outpatient | 1 | $93 | $93 | — | — | — | $93 – $93 |
| 13 | HANFORD COMMUNITY HOSPITAL Selma, CA fee schedule · outpatient | 1 | $93 | $93 | — | — | — | $93 – $93 |
| 14 | INDIAN RIVER MEMORIAL HOSPITAL INC Vero Beach, FL facility · case rate · outpatient | 1 | $75 | $75 | — | — | — | $75 – $75 |
| 15 | IOM Health System LP Fort Wayne, IN facility · other · outpatient | 1 | $386 | $386 | — | — | — | $386 – $386 |
| 16 | LODI MEMORIAL HOSPITAL ASSOCIATION INC Lodi, CA fee schedule · outpatient | 1 | $93 | $93 | — | — | — | $93 – $93 |
| 17 | Mercy Hospital Southeast Girardeau, MO professional · fee schedule · inpatient | 1 | $98 | $98 | — | — | — | $98 – $98 |
| 18 | Mercy Hospital Southeast Girardeau, MO professional · fee schedule · outpatient | 1 | $98 | $98 | — | — | — | $98 – $98 |
| 19 | Mercy Hospital Southeast Girardeau, MO professional · fee schedule · inpatient | 1 | $98 | $98 | — | — | — | $98 – $98 |
| 20 | Mercy Hospital Southeast Girardeau, MO professional · fee schedule · outpatient | 1 | $98 | $98 | — | — | — | $98 – $98 |
| 21 | Montefiore Medical Center Bronx, NY fee schedule · outpatient | 1 | $232 | $232 | — | — | — | $232 – $232 |
| 22 | Montefiore Mount Vernon Hospital Mount Vernon, NY fee schedule · outpatient | 1 | $232 | $232 | — | — | — | $232 – $232 |
| 23 | Montefiore New Rochelle Hospital New Rochelle, NY fee schedule · outpatient | 1 | $232 | $232 | — | — | — | $232 – $232 |
| 24 | REEDLEY COMMUNITY HOSPITAL Reedley, CA fee schedule · outpatient | 1 | $93 | $93 | — | — | — | $93 – $93 |
| 25 | SAN JOAQUIN COMMUNITY HOSPITAL Bakersfield, CA fee schedule · outpatient | 1 | $93 | $93 | — | — | — | $93 – $93 |
← Payers reporting CPT 77262 · Snapshot 20261112T181611Z-3fa9fb76