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
$10
Average
$78
Median
$86
High
$180
Each hospital's average Medicaid rate, under the methodology and billing class chosen below.
16 hospitals; the 90th percentile is 7.5× 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
16 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 | ADVENTIST HEALTH MEDICAL CENTER TEHACHAPI Tehachapi, CA fee schedule · outpatient | 1 | $86 | $86 | $33 | 38% | — | $53 – $119 |
| 2 | ADVENTIST HEALTH MENDOCINO COAST Bragg, CA fee schedule · outpatient | 1 | $86 | $86 | $33 | 38% | — | $53 – $119 |
| 3 | ADVENTIST HEALTH TULARE Tulare, CA fee schedule · outpatient | 1 | $119 | $119 | — | — | — | $119 – $119 |
| 4 | GLENDALE ADVENTIST MEDICAL CENTER Glendale, CA fee schedule · outpatient | 1 | $32 | $32 | — | — | — | $32 – $32 |
| 5 | HANFORD COMMUNITY HOSPITAL Selma, CA fee schedule · outpatient | 1 | $119 | $119 | — | — | — | $119 – $119 |
| 6 | Hospital Authority of Colquitt County Moultrie, GA fee schedule · both | 1 | $27 | $27 | — | — | — | $27 – $27 |
| 7 | LODI MEMORIAL HOSPITAL ASSOCIATION INC Lodi, CA fee schedule · outpatient | 1 | $119 | $97 | $31 | 32% | — | $53 – $119 |
| 8 | Mercy Hospital Jefferson Imperial, MO facility · percent of total billed charges · outpatientfrom % of charges | 1 | $17 | $17 | — | — | — | $17 – $17 |
| 9 | Mercy Hospitals East Communities dba Mercy Hospital Washington Washington, MO facility · percent of total billed charges · outpatientfrom % of charges | 1 | $15 | $15 | — | — | — | $15 – $15 |
| 10 | REEDLEY COMMUNITY HOSPITAL Reedley, CA fee schedule · outpatient | 1 | $119 | $97 | $31 | 32% | — | $53 – $119 |
| 11 | SAN JOAQUIN COMMUNITY HOSPITAL Bakersfield, CA fee schedule · outpatient | 1 | $119 | $119 | — | — | — | $119 – $119 |
| 12 | SONORA COMMUNITY HOSPITAL Sonora, CA fee schedule · outpatient | 1 | $46 | $60 | $35 | 59% | — | $29 – $119 |
| 13 | Ste. Genevieve County Memorial Hospital Ste. Genevieve, MO percent of total billed charges · outpatientfrom % of charges | 1 | $10 | $10 | — | — | — | $10 – $10 |
| 14 | UKIAH ADVENTIST HOSPITAL Ukiah, CA fee schedule · outpatient | 1 | $86 | $86 | $33 | 38% | — | $53 – $119 |
| 15 | WHITE MEMORIAL MEDICAL CENTER MONTEBELLO, CA fee schedule · outpatient | 1 | $180 | $180 | $148 | 82% | — | $32 – $329 |
| 16 | WILLITS HOSPITAL INC Willits, CA fee schedule · outpatient | 1 | $119 | $97 | $31 | 32% | — | $53 – $119 |
← Payers reporting CPT 99080 · Snapshot 20261113T090226Z-3ce6c0b8