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
Im Adm Thru 18yr Any Rte Addl Vac/Tox Compt
Low
$10
Average
$44
Median
$19
High
$763
Each hospital's average Premera rate, under the methodology and billing class chosen below.
35 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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55 hospital rates
iThe hospitals that file a Premera 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 | Mishawaka Medical Center Mishawaka, IN professional · fee schedule · both | 1 | $15 | $15 | — | — | 2–20 | $15 – $15 |
| 2 | Mercy Health Saint Marys Rockford, MI professional · fee schedule · outpatient | 1 | $15 | $15 | — | — | 1–10 | $15 – $15 |
| 3 | Samaritan Hospital Troy, NY professional · percent of total billed charges · outpatientfrom % of charges | 1 | $26 | $26 | — | — | 1–10 | $26 – $26 |
| 4 | Columbia Lutheran Charities Astoria, OR facility · percent of total billed charges · bothfrom % of charges | 1 | $28 | $27 | $11 | 42% | — | $12 – $40 |
| 5 | Coulee Medical Center Grand Coulee, WA facility · percent of total billed charges · outpatientfrom % of charges | 1 | $24 | $24 | — | — | — | $24 – $24 |
| 6 | Covenant Medical Center Inc Waterloo, IA professional · fee schedule · both | 1 | $11 | $11 | — | — | — | $11 – $11 |
| 7 | Diley Ridge Medical Center Canal Winchester, OH facility · fee schedule · both | 1 | $11 | $11 | — | — | — | $11 – $11 |
| 8 | Holy Cross Germantown Hospital Germantown, MD facility · percent of total billed charges · bothfrom % of charges | 1 | $59 | $59 | — | — | — | $59 – $59 |
| 9 | Holy Cross Hospital-Ft. Lauderdale Ft. Lauderdale, FL facility · per diem · both | 1 | $763 | $763 | — | — | — | $763 – $763 |
| 10 | Holy Cross Hospital-Silver Spring Silver Spring, MD facility · percent of total billed charges · bothfrom % of charges | 1 | $57 | $57 | — | — | — | $57 – $57 |
| 11 | Mercy Health Hackley Campus Muskogen, MI facility · fee schedule · both | 1 | $48 | $48 | — | — | — | $48 – $48 |
| 12 | Mercy Health Hackley Campus Muskogen, MI professional · fee schedule · inpatient | 1 | $15 | $15 | — | — | — | $15 – $15 |
| 13 | Mercy Health Hackley Campus Muskogen, MI professional · fee schedule · outpatient | 1 | $13 | $13 | — | — | — | $13 – $13 |
| 14 | Mercy Health Lakeshore Campus Shelby, MI facility · percent of total billed charges · bothfrom % of charges | 1 | $20 | $20 | — | — | — | $20 – $20 |
| 15 | Mercy Health Lakeshore Campus Shelby, MI professional · fee schedule · inpatient | 1 | $15 | $15 | — | — | — | $15 – $15 |
| 16 | Mercy Health Lakeshore Campus Shelby, MI professional · fee schedule · outpatient | 1 | $13 | $13 | — | — | — | $13 – $13 |
| 17 | Mercy Health Saint Marys Rockford, MI facility · fee schedule · both | 1 | $32 | $32 | — | — | — | $32 – $32 |
| 18 | Mercy Health Saint Marys Rockford, MI professional · fee schedule · inpatient | 1 | $15 | $15 | — | — | — | $15 – $15 |
| 19 | Mercy Health Services-Iowa Corp. Mason City, IA professional · fee schedule · inpatient | 1 | $11 | $11 | — | — | — | $11 – $11 |
| 20 | Mercy Health Services-Iowa Corp. Mason City, IA professional · fee schedule · outpatient | 1 | $11 | $11 | — | — | — | $11 – $11 |
| 21 | Mercy Medical Center - Dubuque Dubuque, IA professional · fee schedule · inpatient | 1 | $11 | $11 | — | — | — | $11 – $11 |
| 22 | Mercy Medical Center - Dubuque Dubuque, IA professional · fee schedule · outpatient | 1 | $11 | $11 | — | — | — | $11 – $11 |
| 23 | Mount Carmel East Reynoldsburg, OH facility · fee schedule · both | 1 | $11 | $11 | — | — | — | $11 – $11 |
| 24 | Mount Carmel Grove City Grove City, OH facility · fee schedule · both | 1 | $11 | $11 | — | — | — | $11 – $11 |
| 25 | Mount Carmel New Albany Surgical Hospital New Albany, OH facility · fee schedule · both | 1 | $11 | $11 | — | — | — | $11 – $11 |
← Payers reporting CPT 90461 · Snapshot 20261111T120946Z-9134e7f7