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
Fee Schedule
Low
$28
Average
$1.4k
Median
$128
High
$25k
Each hospital's average Molina rate, under the methodology and billing class chosen below.
22 hospitals; the 90th percentile is 8.9× 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
26 hospital rates
iThe hospitals that file a Molina 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 | Baptist Memorial Hospital-Calhoun Calhoun City, MS facility · percent of total billed charges · outpatientfrom % of charges | 3 | $105 | $135 | $42 | 31% | — | $105 – $195 |
| 2 | Carle BroMenn Medical Center Normal, IL percent of total billed charges · inpatientfrom % of charges | 2 | $73 | $73 | — | — | — | $73 – $73 |
| 3 | Carle BroMenn Medical Center Normal, IL percent of total billed charges · outpatientfrom % of charges | 2 | $73 | $73 | — | — | — | $73 – $73 |
| 4 | Carle Eureka Hospital Eureka, IL percent of total billed charges · inpatientfrom % of charges | 2 | $73 | $73 | — | — | — | $73 – $73 |
| 5 | Carle Eureka Hospital Eureka, IL percent of total billed charges · outpatientfrom % of charges | 2 | $124 | $124 | $51 | 41% | — | $73 – $175 |
| 6 | Childrens Hospital at Mission - Cerner 27700 Medical Center Rd facility · fee schedule · outpatient | 1 | $82 | $82 | — | — | — | $82 – $82 |
| 7 | Childrens Hospital of Orange County - Profit Orange, CA facility · fee schedule · outpatient | 1 | $82 | $82 | — | — | — | $82 – $82 |
| 8 | Coshocton Regional Medical Center Coshocton, OH fee schedule · outpatient | 3 | $72 | $121 | $86 | 71% | — | $50 – $243 |
| 9 | East Liverpool City Hospital Liverpool, OH fee schedule · outpatient | 3 | $72 | $117 | $80 | 69% | — | $50 – $230 |
| 10 | Fairfield Medical Center 401 N Ewing St facility · other · outpatient | 1 | $25k | $25k | — | — | — | $25k – $25k |
| 11 | Gottlieb Memorial Hospital Melrose Park, IL facility · case rate · outpatient | 1 | $604 | $604 | — | — | — | $604 – $604 |
| 12 | Gundersen Luthern Medical Center Inc La Crosse, WI facility · fee schedule · outpatient | 1 | $275 | $275 | — | — | — | $275 – $275 |
| 13 | Gundersen Palmer Lutheran Hospital and Clinic Inc West Union, IA facility · fee schedule · outpatient | 1 | $275 | $275 | — | — | — | $275 – $275 |
| 14 | Henry Ford Health Novi, MI fee schedule · both | 1 | $68 | $68 | — | — | — | $68 – $68 |
| 15 | Henry Ford Health Southfield, MI fee schedule · both | 1 | $68 | $68 | — | — | — | $68 – $68 |
| 16 | Loyola University Medical Center Maywood, IL facility · case rate · outpatient | 1 | $875 | $875 | — | — | — | $875 – $875 |
| 17 | MacNeal Hospital Berwyn, IL facility · case rate · outpatient | 1 | $604 | $604 | — | — | — | $604 – $604 |
| 18 | Montefiore Medical Center Bronx, NY fee schedule · outpatient | 4 | $160 | $210 | $87 | 41% | — | $160 – $361 |
| 19 | Montefiore Mount Vernon Hospital Mount Vernon, NY fee schedule · outpatient | 4 | $163 | $214 | $88 | 41% | — | $163 – $368 |
| 20 | Montefiore New Rochelle Hospital New Rochelle, NY fee schedule · outpatient | 4 | $163 | $213 | $86 | 40% | — | $163 – $361 |
| 21 | Richland Memorial Hospital Inc Olney, IL percent of total billed charges · inpatientfrom % of charges | 1 | $64 | $64 | $4 | 6% | — | $60 – $68 |
| 22 | Richland Memorial Hospital Inc Olney, IL percent of total billed charges · outpatientfrom % of charges | 2 | $54 | $54 | $10 | 19% | — | $42 – $68 |
| 23 | Sarasota Memorial Hospital Sarasota, FL fee schedule · outpatient | 2 | $28 | $28 | — | — | — | $28 – $28 |
| 24 | The Carle Foundation Hospital Urbana, IL percent of total billed charges · inpatientfrom % of charges | 2 | $83 | $101 | $37 | 37% | — | $62 – $156 |
| 25 | The Carle Foundation Hospital Urbana, IL percent of total billed charges · outpatientfrom % of charges | 2 | $83 | $101 | $37 | 37% | — | $62 – $156 |
← Payers reporting CPT 96111 · Snapshot 20261112T124536Z-e251e855