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
facility
Low
$13
Average
$60
Median
$47
High
$186
Each hospital's average Medicaid rate, under the methodology and billing class chosen below.
27 hospitals; the 90th percentile is 4.6× 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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28 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 DELANO Delano, CA fee schedule · outpatient | 1 | $75 | $75 | — | — | — | $75 – $75 |
| 2 | Allina Health Systems Ulm, MN facility · other · outpatient | 1 | $176 | $176 | — | — | — | $176 – $176 |
| 3 | CATHOLIC HEALTH INITIATIVES COLORADO Salt Lake City, UT fee schedule · outpatient | 1 | $50 | $50 | — | — | — | $50 – $50 |
| 4 | CentraState Medical Center Freehold Township, NJ fee schedule · outpatient | 1 | $47 | $47 | — | — | — | $47 – $47 |
| 5 | Chilton Medical Center Pompton Plains, NJ fee schedule · outpatient | 1 | $47 | $47 | — | — | — | $47 – $47 |
| 6 | Cleveland Clinic Weston Hospital Nonprofit Corporation Weston, FL facility · case rate · outpatient | 1 | $23 | $23 | — | — | — | $23 – $23 |
| 7 | Emerson Hospital Concord, MA facility · fee schedule · outpatient | 1 | $52 | $52 | — | — | — | $52 – $52 |
| 8 | Grossmont Hospital Corporation La Mesa, CA percent of total billed charges · outpatientfrom % of charges | 1 | $13 | $13 | — | — | — | $13 – $13 |
| 9 | Hackettstown Medical Center Hackettstown, NJ fee schedule · outpatient | 1 | $47 | $47 | — | — | — | $47 – $47 |
| 10 | HealthAlliance - Clinton Hospital MA 01453; 201 Highland St Clinton, MA fee schedule · both | 3 | $52 | $50 | $7 | 14% | — | $41 – $58 |
| 11 | Henry Ford Health Novi, MI other · outpatient | 1 | $34 | $34 | — | — | — | $34 – $34 |
| 12 | Henry Ford Health Twp, MI other · outpatient | 1 | $34 | $34 | — | — | — | $34 – $34 |
| 13 | Henry Ford Health Southfield, MI other · outpatient | 1 | $34 | $34 | — | — | — | $34 – $34 |
| 14 | Henry Ford Health Rochester, MI other · outpatient | 1 | $32 | $32 | — | — | — | $32 – $32 |
| 15 | INDIAN RIVER MEMORIAL HOSPITAL INC Vero Beach, FL facility · case rate · outpatient | 1 | $23 | $23 | — | — | — | $23 – $23 |
| 16 | Lake Charles Memorial Hospital Charles., LA percent of total billed charges · outpatientfrom % of charges | 1 | $103 | $103 | — | — | — | $103 – $103 |
| 17 | Methodist Hospitals of Dallas Mansfield, TX fee schedule · both | 1 | $49 | $49 | — | — | — | $49 – $49 |
| 18 | Methodist Hospitals of Dallas Midlothian, TX fee schedule · both | 1 | $49 | $49 | — | — | — | $49 – $49 |
| 19 | Methodist Hospitals of Dallas Dallas, TX fee schedule · both | 1 | $49 | $49 | — | — | — | $49 – $49 |
| 20 | Methodist Hospitals of Dallas Richardson, TX fee schedule · both | 1 | $49 | $49 | — | — | — | $49 – $49 |
| 21 | Methodist Hospitals of Dallas Richardson, TX fee schedule · both | 1 | $49 | $49 | — | — | — | $49 – $49 |
| 22 | Morristown Medical Center Morristown, NJ fee schedule · outpatient | 1 | $47 | $47 | — | — | — | $47 – $47 |
| 23 | Newton Medical Center Newton, NJ fee schedule · outpatient | 1 | $47 | $47 | — | — | — | $47 – $47 |
| 24 | Overlook Medical Center Summit, NJ fee schedule · outpatient | 1 | $47 | $47 | — | — | — | $47 – $47 |
| 25 | Sharp Coronado Hospital and Healthcare Center Coronado, CA percent of total billed charges · inpatientfrom % of charges | 1 | $32 | $32 | — | — | — | $32 – $32 |
← Payers reporting CPT 81250 · Snapshot 20261113T090226Z-3ce6c0b8