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
PR PENTOXIFLLINE STIM SPERM
Low
$0
Average
$107
Median
$132
High
$212
Each hospital's average Medicaid rate, under the methodology and billing class chosen below.
35 hospitals; the 90th percentile is 17.3× 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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37 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 | ARTHUR G JAMES CANCER HOSPITAL AND RESEARCH INSTITUTE Columbus, OH percent of total billed charges · inpatientfrom % of charges | 1 | $18 | $18 | — | — | — | $18 – $18 |
| 2 | ARTHUR G JAMES CANCER HOSPITAL AND RESEARCH INSTITUTE Columbus, OH percent of total billed charges · outpatientfrom % of charges | 1 | $15 | $15 | — | — | — | $15 – $15 |
| 3 | BYRD REGIONAL HOSPITAL LEESVILLE, LA percent of total billed charges · bothfrom % of charges | 5 | $11 | $11 | $0 | 4% | — | $11 – $12 |
| 4 | CATHOLIC HEALTH INITIATIVES COLORADO Salt Lake City, UT fee schedule · outpatient | 1 | $53 | $53 | — | — | — | $53 – $53 |
| 5 | Childrens Hospital of Los Angeles Angeles, CA facility · other · outpatient | 2 | $0 | $0 | — | — | — | $0 – $0 |
| 6 | Childrens Hospital of Los Angeles Angeles, CA professional · fee schedule · outpatient | 2 | $0 | $0 | — | — | — | $0 – $0 |
| 7 | Cleveland Clinic Weston Hospital Nonprofit Corporation Weston, FL facility · case rate · outpatient | 1 | $12 | $12 | — | — | — | $12 – $12 |
| 8 | Dupont Hospital LLC Wayne, IN facility · other · outpatient | 1 | $174 | $174 | — | — | — | $174 – $174 |
| 9 | FRANCISCAN ALLIANCE, INC. dba FRANCISCAN HEALTH CARMEL CARMEL, IN percent of total billed charges · bothfrom % of charges | 2 | $212 | $212 | $19 | 9% | — | $193 – $232 |
| 10 | FRANCISCAN ALLIANCE, INC. dba FRANCISCAN HEALTH CRAWFORDSVILLE CRAWFORDSVILLE, IN percent of total billed charges · bothfrom % of charges | 1 | $193 | $193 | — | — | — | $193 – $193 |
| 11 | FRANCISCAN ALLIANCE, INC. dba FRANCISCAN HEALTH CROWN POINT CROWN POINT, IN percent of total billed charges · bothfrom % of charges | 14 | $154 | $162 | $13 | 8% | — | $154 – $185 |
| 12 | FRANCISCAN ALLIANCE, INC. dba FRANCISCAN HEALTH DYER DYER, IN percent of total billed charges · bothfrom % of charges | 14 | $146 | $153 | $13 | 8% | — | $146 – $175 |
| 13 | FRANCISCAN ALLIANCE, INC. dba FRANCISCAN HEALTH INDIANAPOLIS INDIANAPOLIS, IN percent of total billed charges · bothfrom % of charges | 16 | $193 | $201 | $16 | 8% | — | $193 – $232 |
| 14 | FRANCISCAN ALLIANCE, INC. dba FRANCISCAN HEALTH LAFAYETTE LAFAYETTE, IN percent of total billed charges · bothfrom % of charges | 2 | $195 | $195 | $18 | 9% | — | $177 – $213 |
| 15 | FRANCISCAN ALLIANCE, INC. dba FRANCISCAN HEALTH MICHIGAN CITY CITY, IN percent of total billed charges · bothfrom % of charges | 2 | $178 | $178 | $16 | 9% | — | $162 – $194 |
| 16 | FRANCISCAN ALLIANCE, INC. dba FRANCISCAN HEALTH MICHIGAN CITY LAPORTE PORTE, IN percent of total billed charges · bothfrom % of charges | 2 | $178 | $178 | $16 | 9% | — | $162 – $194 |
| 17 | FRANCISCAN ALLIANCE, INC. dba FRANCISCAN HEALTH MOORESVILLE MOORESVILLE, IN percent of total billed charges · bothfrom % of charges | 2 | $212 | $212 | $19 | 9% | — | $193 – $232 |
| 18 | FRANCISCAN ALLIANCE, INC. dba FRANCISCAN HEALTH MUNSTER MUNSTER, IN percent of total billed charges · bothfrom % of charges | 2 | $212 | $212 | $19 | 9% | — | $193 – $232 |
| 19 | FRANCISCAN HEALTH RENSSELAER, INC. RENSSELAER, IN percent of total billed charges · bothfrom % of charges | 2 | $198 | $198 | $18 | 9% | — | $180 – $216 |
| 20 | Geisinger Medical Center Muncy, PA fee schedule · outpatient | 1 | $1 | $1 | — | — | — | $1 – $1 |
| 21 | Henry Ford Health Novi, MI other · outpatient | 1 | $30 | $30 | — | — | — | $30 – $30 |
| 22 | Henry Ford Health Twp, MI other · outpatient | 1 | $31 | $31 | — | — | — | $31 – $31 |
| 23 | Henry Ford Health Southfield, MI other · outpatient | 1 | $30 | $30 | — | — | — | $30 – $30 |
| 24 | Henry Ford Health Rochester, MI other · outpatient | 1 | $28 | $28 | — | — | — | $28 – $28 |
| 25 | INDIAN RIVER MEMORIAL HOSPITAL INC Vero Beach, FL facility · case rate · outpatient | 1 | $12 | $12 | — | — | — | $12 – $12 |
← Payers reporting CPT 89240 · Snapshot 20261112T181611Z-3fa9fb76