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
SPECIAL REPORTS OR FORMS
Low
$5
Average
$127
Median
$107
High
$450
Each hospital's average Kaiser rate, under the methodology and billing class chosen below.
22 hospitals; the 90th percentile is 11.0× 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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26 hospital rates
iThe hospitals that file a Kaiser 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 | Central Georgia Rehabilitation LLC Macon, GA fee schedule · both | 1 | $143 | $143 | — | — | — | $143 – $143 |
| 2 | Children's National Hospital Washington, DC professional · fee schedule · both | 1 | $33 | $33 | — | — | — | $33 – $33 |
| 3 | Children's National Hospital Washington, DC professional · percent of total billed charges · bothfrom % of charges | 1 | $51 | $51 | — | — | — | $51 – $51 |
| 4 | GLENDALE ADVENTIST MEDICAL CENTER Glendale, CA percent of total billed charges · outpatientfrom % of charges | 1 | $27 | $27 | — | — | — | $27 – $27 |
| 5 | HANFORD COMMUNITY HOSPITAL Selma, CA fee schedule · outpatient | 1 | $119 | $119 | — | — | — | $119 – $119 |
| 6 | Inova Alexandria Hospital Alexandria, VA other · both | 2 | $196 | $196 | — | — | — | $196 – $196 |
| 7 | Inova Fair Oaks Hospital Fairfax, VA other · both | 2 | $196 | $196 | — | — | — | $196 – $196 |
| 8 | Inova Fairfax Hospital Falls Church, VA other · both | 2 | $196 | $196 | — | — | — | $196 – $196 |
| 9 | Inova Loudoun Hospital Leesburg, VA other · both | 2 | $196 | $196 | — | — | — | $196 – $196 |
| 10 | Inova Mount Vernon Hospital Alexandria, VA other · both | 2 | $196 | $196 | — | — | — | $196 – $196 |
| 11 | LODI MEMORIAL HOSPITAL ASSOCIATION INC Lodi, CA fee schedule · outpatient | 1 | $119 | $97 | $31 | 32% | — | $53 – $119 |
| 12 | LODI MEMORIAL HOSPITAL ASSOCIATION INC Lodi, CA percent of total billed charges · outpatientfrom % of charges | 1 | $49 | $49 | — | — | — | $49 – $49 |
| 13 | Mayo Clinic Rochester, MN professional · percent of total billed charges · outpatientfrom % of charges | 1 | $442 | $450 | $283 | 63% | — | $56 – $884 |
| 14 | Public Hospital District NO 2 Skagit County Washington Anacortes, WA facility · fee schedule · both | 1 | $5 | $5 | — | — | — | $5 – $5 |
| 15 | REEDLEY COMMUNITY HOSPITAL Reedley, CA percent of total billed charges · outpatientfrom % of charges | 1 | $60 | $60 | — | — | — | $60 – $60 |
| 16 | SONORA COMMUNITY HOSPITAL Sonora, CA percent of total billed charges · outpatientfrom % of charges | 1 | $17 | $17 | $2 | 13% | — | $15 – $19 |
| 17 | ST HELENA HOSPITAL Vallejo, CA percent of total billed charges · outpatientfrom % of charges | 1 | $46 | $46 | $16 | 35% | — | $30 – $62 |
| 18 | Samuel Mahelona Memorial Hospital Kapaa, HI professional · per diem · both | 3 | $247 | $267 | $66 | 25% | — | $181 – $434 |
| 19 | St. Charles Madras Madras, OR percent of total billed charges · bothfrom % of charges | 2 | $13 | $13 | $3 | 26% | — | $10 – $16 |
| 20 | Stanford Health Care Stanford, CA percent of total billed charges · bothfrom % of charges | 1 | $187 | $187 | — | — | — | $187 – $187 |
| 21 | The Medical Center of Central Georgia Inc Macon, GA fee schedule · both | 1 | $143 | $143 | — | — | — | $143 – $143 |
| 22 | UCHealth Estes Valley Medical Center Estes Park, CO percent of total billed charges · inpatientfrom % of charges | 2 | $44 | $44 | $13 | 29% | — | $31 – $58 |
| 23 | UCHealth Estes Valley Medical Center Estes Park, CO percent of total billed charges · outpatientfrom % of charges | 2 | $44 | $44 | $13 | 29% | — | $31 – $58 |
| 24 | UKIAH ADVENTIST HOSPITAL Ukiah, CA fee schedule · outpatient | 1 | $86 | $86 | $33 | 38% | — | $53 – $119 |
| 25 | UKIAH ADVENTIST HOSPITAL Ukiah, CA percent of total billed charges · outpatientfrom % of charges | 1 | $69 | $69 | $26 | 38% | — | $42 – $95 |
← Payers reporting CPT 99080 · Snapshot 20261113T090226Z-3ce6c0b8