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
$1
Average
$72
Median
$60
High
$387
Each hospital's average Medicaid rate, under the methodology and billing class chosen below.
158 hospitals; the 90th percentile is 2.7× 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
177 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 | Allina Health Systems Ulm, MN facility · other · outpatient | 1 | $214 | $325 | $267 | 82% | 36 | $43 – $748 |
| 2 | Beebe Medical Center Inc. Lewes, DE facility · percent of total billed charges · outpatientfrom % of charges | 1 | $69 | $69 | — | — | 14 | $69 – $69 |
| 3 | Tufts Medical Center BOSTON, MA other · both | 1 | $100 | $100 | — | — | 6–60 | $100 – $100 |
| 4 | ADVENTIST HEALTH CLEARLAKE HOSPITAL INC Clearlake, CA fee schedule · outpatient | 1 | $56 | $56 | — | — | — | $56 – $56 |
| 5 | ADVENTIST HEALTH DELANO Delano, CA fee schedule · outpatient | 1 | $56 | $56 | — | — | — | $56 – $56 |
| 6 | ADVENTIST HEALTH MEDICAL CENTER TEHACHAPI Tehachapi, CA fee schedule · outpatient | 1 | $47 | $47 | $8 | 18% | — | $39 – $56 |
| 7 | ADVENTIST HEALTH MENDOCINO COAST Bragg, CA fee schedule · outpatient | 1 | $56 | $56 | — | — | — | $56 – $56 |
| 8 | ADVENTIST HEALTH TULARE Tulare, CA fee schedule · outpatient | 1 | $56 | $50 | $8 | 16% | — | $39 – $56 |
| 9 | ARTHUR G JAMES CANCER HOSPITAL AND RESEARCH INSTITUTE Columbus, OH percent of total billed charges · inpatientfrom % of charges | 1 | $150 | $150 | — | — | — | $150 – $150 |
| 10 | ARTHUR G JAMES CANCER HOSPITAL AND RESEARCH INSTITUTE Columbus, OH percent of total billed charges · outpatientfrom % of charges | 1 | $121 | $121 | — | — | — | $121 – $121 |
| 11 | Allina Health Systems Shakopee, MN facility · fee schedule · outpatient | 1 | $70 | $70 | — | — | — | $70 – $70 |
| 12 | Allina Health Systems MN; 1175 Nininger Road. Hastings, MN facility · fee schedule · outpatient | 1 | $70 | $70 | — | — | — | $70 – $70 |
| 13 | Allina Health Systems Owatonna, MN facility · fee schedule · outpatient | 1 | $70 | $70 | — | — | — | $70 – $70 |
| 14 | Allina Health Systems MN 55443; 550 Osborne Road NE. Fridley, MN facility · fee schedule · outpatient | 1 | $70 | $70 | — | — | — | $70 – $70 |
| 15 | Allina Health Systems Cambridge, MN facility · fee schedule · outpatient | 1 | $70 | $70 | — | — | — | $70 – $70 |
| 16 | Allina Health Systems River Falls, WI facility · fee schedule · outpatient | 1 | $70 | $70 | — | — | — | $70 – $70 |
| 17 | Allina Health Systems Minneapolis, MN facility · fee schedule · outpatient | 1 | $70 | $70 | — | — | — | $70 – $70 |
| 18 | Allina Health Systems Buffalo, MN facility · fee schedule · outpatient | 1 | $70 | $70 | — | — | — | $70 – $70 |
| 19 | BAPTIST HOSPITAL OF MIAMI PLANTATION, FL fee schedule · both | 2 | $32 | $32 | $2 | 5% | — | $30 – $33 |
| 20 | BETHESDA HOSPITAL BOYNTON BEACH, FL fee schedule · both | 2 | $32 | $32 | $2 | 5% | — | $30 – $33 |
| 21 | Boston Medical Center Boston, MA fee schedule · both | 1 | $62 | $62 | — | — | — | $62 – $62 |
| 22 | Boston Medical Center Brighton Boston, MA fee schedule · both | 1 | $62 | $62 | — | — | — | $62 – $62 |
| 23 | Boston Medical Center South Brockton, MA fee schedule · both | 1 | $62 | $62 | — | — | — | $62 – $62 |
| 24 | Brookings Health System Brookings, SD fee schedule · outpatient | 1 | $70 | $70 | — | — | — | $70 – $70 |
| 25 | Butler Healthcare Providers_ DBA Butler Memorial Hospital Butler, PA facility · fee schedule · outpatient | 1 | $39 | $39 | — | — | — | $39 – $39 |
← Payers reporting CPT 87801 · Snapshot 20261111T120946Z-9134e7f7