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
Intake Evaluation Php
Low
$101
Average
$287
Median
$212
High
$722
Each hospital's average Premera rate, under the methodology and billing class chosen below.
48 hospitals; the 90th percentile is 3.7× 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.
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76 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 | Seattle Children's Hospital Seattle, WA professional · fee schedule · both | 3 | $288 | $288 | — | — | 276 | $288 – $288 |
| 2 | Catholic Health Initiatives-Iowa Corp Des Moines, IA professional · fee schedule · both | 1 | $160 | $160 | — | — | 1–10 | $160 – $160 |
| 3 | Catholic Health Initiatives-Iowa Corp Des Moines, IA facility · fee schedule · both | 1 | $181 | $181 | — | — | — | $181 – $181 |
| 4 | Central Washington Health Services Association Wenatchee, WA fee schedule · both | 5 | $371 | $342 | $50 | 15% | — | $223 – $371 |
| 5 | Central Washington Health Services Association Wenatchee, WA percent of total billed charges · outpatientfrom % of charges | 3 | $180 | $175 | $6 | 4% | — | $163 – $180 |
| 6 | Clallam County Public Hospital District 2 DBA Olympic Medical Center Port Angeles, WA fee schedule · inpatient | 1 | $205 | $205 | — | — | — | $205 – $205 |
| 7 | Clallam County Public Hospital District 2 DBA Olympic Medical Center Port Angeles, WA fee schedule · outpatient | 1 | $205 | $205 | — | — | — | $205 – $205 |
| 8 | Columbia Lutheran Charities Astoria, OR facility · percent of total billed charges · bothfrom % of charges | 1 | $394 | $332 | $127 | 38% | — | $101 – $435 |
| 9 | Covenant Medical Center Inc Waterloo, IA facility · fee schedule · both | 1 | $181 | $181 | — | — | — | $181 – $181 |
| 10 | Covenant Medical Center Inc Waterloo, IA professional · fee schedule · both | 1 | $160 | $160 | — | — | — | $160 – $160 |
| 11 | Good Samaritan Hospital Puyallup, WA fee schedule · outpatient | 4 | $589 | $546 | $168 | 31% | — | $273 – $732 |
| 12 | Holy Cross Germantown Hospital Germantown, MD professional · percent of total billed charges · bothfrom % of charges | 1 | $307 | $307 | — | — | — | $307 – $307 |
| 13 | Holy Cross Hospital-Ft. Lauderdale Ft. Lauderdale, FL facility · per diem · both | 1 | $763 | $763 | — | — | — | $763 – $763 |
| 14 | Holy Cross Hospital-Ft. Lauderdale Ft. Lauderdale, FL professional · fee schedule · both | 1 | $163 | $163 | — | — | — | $163 – $163 |
| 15 | Holy Cross Hospital-Silver Spring Silver Spring, MD professional · percent of total billed charges · bothfrom % of charges | 1 | $307 | $307 | — | — | — | $307 – $307 |
| 16 | Johnson Memorial Hospital Stafford Springs, CT facility · case rate · both | 1 | $328 | $328 | — | — | — | $328 – $328 |
| 17 | Johnson Memorial Hospital Stafford Springs, CT professional · fee schedule · inpatient | 1 | $117 | $117 | — | — | — | $117 – $117 |
| 18 | Johnson Memorial Hospital Stafford Springs, CT professional · fee schedule · outpatient | 1 | $117 | $117 | — | — | — | $117 – $117 |
| 19 | Mary Bridge Children's Hospital Tacoma, WA fee schedule · outpatient | 4 | $589 | $546 | $168 | 31% | — | $273 – $732 |
| 20 | Mercy Fitzgerald Hospital Darby, PA professional · fee schedule · inpatient | 1 | $166 | $166 | — | — | — | $166 – $166 |
| 21 | Mercy Fitzgerald Hospital Darby, PA professional · fee schedule · outpatient | 1 | $166 | $166 | — | — | — | $166 – $166 |
| 22 | Mercy Health Hackley Campus Muskogen, MI facility · percent of total billed charges · bothfrom % of charges | 1 | $132 | $132 | — | — | — | $132 – $132 |
| 23 | Mercy Health Hackley Campus Muskogen, MI professional · fee schedule · both | 1 | $184 | $184 | — | — | — | $184 – $184 |
| 24 | Mercy Health Lakeshore Campus Shelby, MI professional · fee schedule · inpatient | 1 | $217 | $217 | — | — | — | $217 – $217 |
| 25 | Mercy Health Lakeshore Campus Shelby, MI professional · fee schedule · outpatient | 1 | $184 | $184 | — | — | — | $184 – $184 |
← Payers reporting CPT 90791 · Snapshot 20261111T120946Z-9134e7f7