CPT 81404
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
MOPATH PROCEDURE L5
Low
$25
Average
$459
Median
$307
High
$15.7k
Each hospital's average UnitedHealthcare rate, under the methodology and billing class chosen below.
1733 hospitals; the 90th percentile is 3.9× 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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2,708 hospital rates
iThe hospitals that file a UnitedHealthcare 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 | Mayo Clinic Rochester, MN facility · percent of total billed charges · bothfrom % of charges | 3 | $286 | $403 | $385 | 96% | 52–520 | $4 – $1.3k |
| 2 | LUCILE SALTER PACKARD CHILDREN'S HOSPITAL AT STANFORD PALO ALTO, CA per diem · outpatient | 1 | $28.5k | $15.7k | $14.2k | 90% | 39–390 | $22 – $28.5k |
| 3 | DIGNITY HEALTH Phoenix, AZ fee schedule · outpatient | 7 | $234 | $233 | $146 | 63% | 33–330 | $1 – $1.1k |
| 4 | Mayo Clinic Arizona Phoenix, AZ facility · percent of total billed charges · bothfrom % of charges | 2 | $271 | $353 | $288 | 81% | 28–280 | $14 – $993 |
| 5 | STATE OF MISSISSIPPI-UNIVERSITY OF MISSISSIPPI MEDICAL CENTER JACKSON, MS other · outpatient | 1 | $165 | $165 | — | — | 18–180 | $165 – $165 |
| 6 | STATE OF MISSISSIPPI-UNIVERSITY OF MISSISSIPPI MEDICAL CENTER JACKSON, MS fee schedule · outpatient | 1 | $275 | $275 | — | — | 13–22 | $275 – $275 |
| 7 | Benefis Hospitals Inc Helena, MT percent of total billed charges · bothfrom % of charges | 1 | $1.0k | $1.8k | $1.7k | 95% | 10–100 | $138 – $5.5k |
| 8 | Newton Wellesley Hospital Newton, MA percent of total billed charges · outpatientfrom % of charges | 1 | $1.4k | $1.4k | — | — | 3–30 | $1.4k – $1.4k |
| 9 | University of New Mexico Hospital | UNM Sandoval Regional Medical Center - A Campus of UNM Hospital Rio Rancho, NM facility · other · outpatient | 2 | $275 | $288 | $15 | 5% | 3–30 | $275 – $305 |
| 10 | TRINITY HOSPITAL HOLDING COMPANY St.Clairsville, OH fee schedule · outpatient | 3 | $325 | $625 | $460 | 74% | 2–20 | $275 – $1.3k |
| 11 | Arkansas Childrens Hospital Little Rock, AR facility · percent of total billed charges · outpatientfrom % of charges | 1 | $147 | $147 | — | — | 1–10 | $147 – $147 |
| 12 | Barnes Jewish Hospital St. Louis, MO fee schedule · both | 2 | $305 | $305 | $25 | 8% | 1–10 | $280 – $330 |
| 13 | North Carolina Baptist Hospital Winston Salem, NC percent of total billed charges · outpatientfrom % of charges | 3 | $35 | $32 | $6 | 17% | 1–10 | $24 – $36 |
| 14 | North Carolina Baptist Hospital Bermuda Run, NC percent of total billed charges · outpatientfrom % of charges | 1 | $23 | $23 | — | — | 1–10 | $23 – $23 |
| 15 | St. Peter's Health Helena, MT percent of total billed charges · inpatientfrom % of charges | 1 | $847 | $847 | — | — | 1–10 | $847 – $847 |
| 16 | St. Peter's Health Helena, MT percent of total billed charges · outpatientfrom % of charges | 1 | $847 | $847 | — | — | 1–10 | $847 – $847 |
| 17 | Strong Memorial Hospital Rochester, NY percent of total billed charges · outpatientfrom % of charges | 1 | $115 | $115 | — | — | 1–10 | $115 – $115 |
| 18 | "Savoy Medical Management Group, Inc." Mamou, LA facility · fee schedule · outpatient | 5 | $294 | $287 | $10 | 3% | — | $275 – $294 |
| 19 | ACADIA GENERAL HOSPITAL, INC 1305 CROWLEY RAYNE HWY fee schedule · outpatient | 1 | $275 | $275 | — | — | — | $275 – $275 |
| 20 | ACADIAN MEDICAL CENTER EUNICE, LA fee schedule · both | 2 | $368 | $368 | $120 | 33% | — | $247 – $488 |
| 21 | ACADIAN MEDICAL CENTER EUNICE, LA percent of total billed charges · bothfrom % of charges | 2 | $200 | $200 | — | — | — | $200 – $200 |
| 22 | ADVENTIST HEALTH CLEARLAKE HOSPITAL INC Clearlake, CA fee schedule · outpatient | 1 | $1.0k | $1.2k | $629 | 55% | — | $327 – $2.5k |
| 23 | ADVENTIST HEALTH CLEARLAKE HOSPITAL INC Clearlake, CA percent of total billed charges · outpatientfrom % of charges | 2 | $302 | $341 | $186 | 55% | — | $94 – $751 |
| 24 | ADVENTIST HEALTH DELANO Delano, CA other · outpatient | 1 | $275 | $275 | — | — | — | $275 – $275 |
| 25 | ADVENTIST HEALTH DELANO Delano, CA percent of total billed charges · outpatientfrom % of charges | 3 | $306 | $382 | $310 | 81% | — | $81 – $1.2k |
← Payers reporting CPT 81404 · Snapshot 20261113T090226Z-3ce6c0b8