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
$0
Average
$479
Median
$65
High
$25k
Each hospital's average Molina rate, under the methodology and billing class chosen below.
72 hospitals; the 90th percentile is 75.4× 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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93 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 | AKRON GENERAL MEDICAL CENTER Akron, OH facility · case rate · outpatient | 1 | $356 | $356 | — | — | — | $356 – $356 |
| 2 | Aurora Medical Center Bay Area Marinette, WI case rate · outpatient | 1 | $74 | $74 | — | — | — | $74 – $74 |
| 3 | BELLEVUE MEDICAL CENTER LLC Bellevue, NE fee schedule · outpatient | 1 | $32 | $32 | — | — | — | $32 – $32 |
| 4 | BELLEVUE MEDICAL CENTER LLC Bellevue, NE percent of total billed charges · outpatientfrom % of charges | 1 | $14 | $14 | — | — | — | $14 – $14 |
| 5 | Baptist Memorial Hospital-Collierville Collierville, TN facility · percent of total billed charges · inpatientfrom % of charges | 1 | $17 | $21 | $10 | 47% | — | $8 – $34 |
| 6 | Baptist Memorial Hospital-Collierville Collierville, TN facility · percent of total billed charges · outpatientfrom % of charges | 2 | $17 | $21 | $10 | 47% | — | $8 – $34 |
| 7 | Baptist Memorial Hospital-Memphis Memphis, TN facility · percent of total billed charges · inpatientfrom % of charges | 1 | $17 | $21 | $10 | 47% | — | $8 – $34 |
| 8 | Baptist Memorial Hospital-Memphis Memphis, TN facility · percent of total billed charges · outpatientfrom % of charges | 2 | $17 | $21 | $10 | 47% | — | $8 – $34 |
| 9 | Baptist Memorial Hospital-Women's Memphis, TN facility · percent of total billed charges · inpatientfrom % of charges | 1 | $17 | $21 | $10 | 47% | — | $8 – $34 |
| 10 | Baptist Memorial Hospital-Women's Memphis, TN facility · percent of total billed charges · outpatientfrom % of charges | 2 | $17 | $21 | $10 | 47% | — | $8 – $34 |
| 11 | CHRISTUS Hospital - Orange Orange, TX percent of total billed charges · outpatientfrom % of charges | 3 | $9 | $9 | — | — | — | $9 – $9 |
| 12 | CHRISTUS West Beaumont Beaumont, TX percent of total billed charges · outpatientfrom % of charges | 3 | $9 | $9 | — | — | — | $9 – $9 |
| 13 | CLEVELAND CLINIC AVON HOSPITAL Avon, OH facility · case rate · outpatient | 1 | $345 | $345 | — | — | — | $345 – $345 |
| 14 | CLEVELAND CLINIC CHILDREN'S HOSPITAL FOR REHABILITATION Cleveland, OH facility · case rate · outpatient | 1 | $623 | $623 | — | — | — | $623 – $623 |
| 15 | CLEVELAND CLINIC HEALTH SYSTEM - EAST REGION Mentor, OH facility · case rate · outpatient | 1 | $383 | $383 | — | — | — | $383 – $383 |
| 16 | CLEVELAND CLINIC HEALTH SYSTEM - EAST REGION Euclid, OH facility · case rate · outpatient | 1 | $391 | $391 | — | — | — | $391 – $391 |
| 17 | CLEVELAND CLINIC HEALTH SYSTEM - EAST REGION Warrensville Heights, OH facility · case rate · outpatient | 1 | $407 | $407 | — | — | — | $407 – $407 |
| 18 | Children's National Hospital Washington, DC professional · fee schedule · both | 2 | $38 | $38 | — | — | — | $38 – $38 |
| 19 | Christus Health Southeast Texas Beaumont, TX percent of total billed charges · outpatientfrom % of charges | 3 | $9 | $9 | — | — | — | $9 – $9 |
| 20 | Christus Health Southeast Texas Port Arthur, TX percent of total billed charges · outpatientfrom % of charges | 3 | $9 | $9 | — | — | — | $9 – $9 |
| 21 | Cleveland Clinic Mercy Hospital Canton, OH facility · case rate · outpatient | 1 | $347 | $347 | — | — | — | $347 – $347 |
| 22 | Columbia Lutheran Charities Astoria, OR facility · percent of total billed charges · bothfrom % of charges | 2 | $148 | $164 | $64 | 39% | — | $88 – $273 |
| 23 | Columbia Lutheran Charities Astoria, OR professional · percent of total billed charges · bothfrom % of charges | 1 | $122 | $122 | — | — | — | $122 – $122 |
| 24 | Deaconess Health System Henderson Hospital Henderson, KY professional · fee schedule · both | 4 | $0 | $0 | — | — | — | $0 – $0 |
| 25 | Deaconess Health System Union County Hospital Morganfield, KY professional · fee schedule · both | 3 | $0 | $0 | — | — | — | $0 – $0 |
← Payers reporting CPT 99080 · Snapshot 20261113T090226Z-3ce6c0b8