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 Ref T3 Free
Low
$0
Average
$49
Median
$30
High
$575
Each hospital's average Ambetter rate, under the methodology and billing class chosen below.
479 hospitals; the 90th percentile is 4.1× 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.
Filter by billing methodology
Filter by billing class
580 hospital rates
iThe hospitals that file a Ambetter 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 Authority of Colquitt County Moultrie, GA fee schedule · both | 1 | $22 | $22 | — | — | 325 | $22 – $22 |
| 2 | Hutchinson Regional Medical Center, Inc. Hutchinson, KS facility · fee schedule · both | 1 | $34 | $34 | — | — | 86 | $34 – $34 |
| 3 | ST JOSEPH REGIONAL HEALTH CENTER Bryan, TX fee schedule · outpatient | 1 | $25 | $25 | — | — | 79 | $25 – $25 |
| 4 | Cheshire Medical Center Keene, NH facility · percent of total billed charges · outpatientfrom % of charges | 1 | $121 | $121 | — | — | 40 | $121 – $121 |
| 5 | Columbus Regional Hospital Columbus, IN fee schedule · both | 1 | $27 | $27 | — | — | 24 | $27 – $27 |
| 6 | STATE OF MISSISSIPPI-UNIVERSITY OF MISSISSIPPI MEDICAL CENTER JACKSON, MS other · outpatient | 1 | $43 | $43 | — | — | 22 | $43 – $43 |
| 7 | Arkansas Childrens Hospital Little Rock, AR facility · percent of total billed charges · outpatientfrom % of charges | 1 | $91 | $91 | — | — | 2–20 | $91 – $91 |
| 8 | Morrison Community Hospital District Morrison, IL facility · fee schedule · both | 1 | $36 | $36 | — | — | 1–10 | $36 – $36 |
| 9 | OKTIBBEHA COUNTY HOSPITAL STARKVILLE, MS other · outpatient | 1 | $19 | $19 | — | — | 1–10 | $19 – $19 |
| 10 | STATE OF MISSISSIPPI-UNIVERSITY OF MISSISSIPPI MEDICAL CENTER GRENADA, MS other · outpatient | 1 | $43 | $43 | — | — | 1–10 | $43 – $43 |
| 11 | Ste. Genevieve County Memorial Hospital Ste. Genevieve, MO percent of total billed charges · outpatientfrom % of charges | 1 | $44 | $44 | — | — | 1–10 | $44 – $44 |
| 12 | VALLEY REGIONAL HOSPITAL CLAREMONT, NH percent of total billed charges · bothfrom % of charges | 1 | $145 | $138 | $9 | 7% | 1–10 | $125 – $145 |
| 13 | Virtua_Memorial_Hospital_Inc | Holly, NJ fee schedule · outpatient | 1 | $36 | $36 | — | — | 1–10 | $36 – $36 |
| 14 | Virtua_Our_Lady_of_Lourdes_Inc Camden, NJ fee schedule · outpatient | 1 | $36 | $36 | — | — | 1–10 | $36 – $36 |
| 15 | ALICE_PECK_DAY_MEMORIAL_HOSPITAL LEBANON, NH fee schedule · outpatient | 1 | $15 | $15 | — | — | — | $15 – $15 |
| 16 | Advocate Childrens Hospital Oak Lawn Oak Lawn, IL facility · case rate · outpatient | 1 | $25 | $25 | — | — | — | $25 – $25 |
| 17 | Advocate Childrens Hospital Park Ridge Park Ridge, IL facility · case rate · outpatient | 1 | $25 | $25 | — | — | — | $25 – $25 |
| 18 | Advocate Christ Medical Center Oak Lawn, IL facility · case rate · outpatient | 1 | $25 | $25 | — | — | — | $25 – $25 |
| 19 | Advocate Condell Medical Center Libertyville, IL case rate · outpatient | 1 | $25 | $25 | — | — | — | $25 – $25 |
| 20 | Advocate Good Samaritan Hospital Downers Grove, IL case rate · outpatient | 1 | $25 | $25 | — | — | — | $25 – $25 |
| 21 | Advocate Good Shepherd Hospital Barrington, IL case rate · outpatient | 1 | $25 | $25 | — | — | — | $25 – $25 |
| 22 | Advocate Illinois Masonic Medical Center Chicago, IL case rate · outpatient | 1 | $25 | $25 | — | — | — | $25 – $25 |
| 23 | Advocate Lutheran General Hospital Park Ridge, IL case rate · outpatient | 1 | $25 | $25 | — | — | — | $25 – $25 |
| 24 | Advocate Sherman Hospital Elgin, IL case rate · outpatient | 1 | $25 | $25 | — | — | — | $25 – $25 |
| 25 | Advocate South Suburban Hospital Hazel Crest, IL case rate · outpatient | 1 | $25 | $25 | — | — | — | $25 – $25 |
← Payers reporting CPT 84481 · Snapshot 20261111T120946Z-9134e7f7