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
Mod Cs Diff Phys<5Yrs 1St 15
Low
$78
Average
$201
Median
$178
High
$409
Each hospital's average Premera rate, under the methodology and billing class chosen below.
8 hospitals; the 90th percentile is 3.1× 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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14 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 | $159 | $159 | — | — | 17–26 | $159 – $159 |
| 2 | Seattle Children's Hospital Seattle, WA facility · percent of total billed charges · bothfrom % of charges | 5 | $241 | $236 | $40 | 17% | 2–20 | $192 – $295 |
| 3 | COMMONSPIRIT OREGON Roseburg, OR fee schedule · inpatient | 1 | $205 | $205 | — | — | — | $205 – $205 |
| 4 | COMMONSPIRIT OREGON Roseburg, OR fee schedule · outpatient | 1 | $218 | $218 | — | — | — | $218 – $218 |
| 5 | Catholic Health Initiatives-Iowa Corp Des Moines, IA professional · fee schedule · inpatient | 1 | $123 | $123 | — | — | — | $123 – $123 |
| 6 | Catholic Health Initiatives-Iowa Corp Des Moines, IA professional · fee schedule · outpatient | 1 | $123 | $123 | — | — | — | $123 – $123 |
| 7 | Central Washington Health Services Association Wenatchee, WA fee schedule · both | 5 | $205 | $190 | $26 | 14% | — | $130 – $205 |
| 8 | Central Washington Health Services Association Wenatchee, WA percent of total billed charges · bothfrom % of charges | 3 | $682 | $665 | $25 | 4% | — | $621 – $682 |
| 9 | Coulee Medical Center Grand Coulee, WA facility · percent of total billed charges · outpatientfrom % of charges | 1 | $308 | $308 | — | — | — | $308 – $308 |
| 10 | ENUMCLAW REGIONAL HOSPITAL ASSOCIATION Enumclaw, WA fee schedule · outpatient | 1 | $78 | $78 | — | — | — | $78 – $78 |
| 11 | Mercy Health Services-Iowa Corp. Mason City, IA professional · fee schedule · inpatient | 1 | $123 | $123 | — | — | — | $123 – $123 |
| 12 | Mercy Health Services-Iowa Corp. Mason City, IA professional · fee schedule · outpatient | 1 | $123 | $123 | — | — | — | $123 – $123 |
| 13 | Virginia Mason Medical Center Seattle, WA facility · percent of total billed charges · outpatientfrom % of charges | 1 | $176 | $176 | — | — | — | $176 – $176 |
| 14 | Virginia Mason Medical Center Seattle, WA professional · fee schedule · outpatient | 2 | $133 | $133 | $47 | 36% | — | $86 – $181 |
← Payers reporting CPT 99155 · Snapshot 20261111T120946Z-9134e7f7