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
ONC FAC OFFICE NEW MOD/HI
Low
$1
Average
$2.7k
Median
$211
High
$3339.9k
Each hospital's average UnitedHealthcare rate, under the methodology and billing class chosen below.
1516 hospitals; the 90th percentile is 5.4× 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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2,592 hospital rates
iThe hospitals that file a UnitedHealthcare 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 | North Arkansas Regional Medical Center Harrison, AR fee schedule · outpatient | 1 | $132 | $132 | — | — | 3,392 | $132 – $132 |
| 2 | North Arkansas Regional Medical Center Harrison, AR fee schedule · inpatient | 1 | $132 | $132 | — | — | 3,351 | $132 – $132 |
| 3 | Saint Francis Hospital and Medical Center Hartford, CT professional · fee schedule · both | 4 | $230 | $214 | $77 | 36% | 2,502–2,511 | $100 – $296 |
| 4 | Stanford Health Care Stanford, CA fee schedule · both | 1 | $612 | $612 | — | — | 2,127–2,199 | $612 – $612 |
| 5 | Mercy Health Saint Marys Rockford, MI professional · fee schedule · outpatient | 4 | $169 | $157 | $26 | 16% | 2,123 | $113 – $177 |
| 6 | Mount Carmel East Reynoldsburg, OH professional · fee schedule · outpatient | 3 | $167 | $167 | $58 | 34% | 2,017 | $97 – $238 |
| 7 | Mayo Clinic Arizona Phoenix, AZ professional · percent of total billed charges · outpatientfrom % of charges | 2 | $438 | $438 | $33 | 7% | 1,702–1,711 | $405 – $471 |
| 8 | Mayo Clinic Rochester, MN professional · percent of total billed charges · outpatientfrom % of charges | 2 | $480 | $480 | — | — | 1,524 | $480 – $480 |
| 9 | Mishawaka Medical Center Mishawaka, IN professional · fee schedule · outpatient | 3 | $164 | $186 | $38 | 21% | 1,438 | $154 – $239 |
| 10 | St Peters Hospital Albany, NY professional · percent of total billed charges · bothfrom % of charges | 1 | $425 | $425 | — | — | 1,432 | $425 – $425 |
| 11 | Mount Carmel St Ann's Lewis Center, OH professional · percent of total billed charges · outpatientfrom % of charges | 1 | $370 | $370 | — | — | 898 | $370 – $370 |
| 12 | Saint Alphonsus Regional Medical Center - Boise Boise, ID professional · fee schedule · both | 3 | $175 | $212 | $74 | 35% | 891 | $146 – $315 |
| 13 | The Mercy Hospital Inc Springfield, MA professional · fee schedule · both | 3 | $166 | $171 | $54 | 31% | 839 | $118 – $234 |
| 14 | Mercy Hospital Springfield Ozark, MO facility · per diem · outpatient | 3 | $315 | $365 | $86 | 24% | 806 | $294 – $487 |
| 15 | Mercy Hospital Springfield Ozark, MO facility · percent of total billed charges · outpatientfrom % of charges | 3 | $187 | $187 | — | — | 806 | $187 – $187 |
| 16 | Mercy Hospital Springfield Springfield, MO facility · per diem · outpatient | 3 | $315 | $365 | $86 | 24% | 806 | $294 – $487 |
| 17 | Mercy Hospital Springfield Springfield, MO facility · percent of total billed charges · outpatientfrom % of charges | 3 | $187 | $187 | — | — | 806 | $187 – $187 |
| 18 | LUCILE SALTER PACKARD CHILDREN'S HOSPITAL AT STANFORD PALO ALTO, CA fee schedule · both | 1 | $612 | $612 | — | — | 710 | $612 – $612 |
| 19 | Seattle Children's Hospital Seattle, WA professional · fee schedule · both | 4 | $237 | $202 | $54 | 27% | 662–671 | $137 – $251 |
| 20 | Samaritan Hospital Troy, NY professional · percent of total billed charges · bothfrom % of charges | 1 | $425 | $425 | — | — | 650 | $425 – $425 |
| 21 | Catholic Health Initiatives-Iowa Corp Des Moines, IA professional · fee schedule · both | 6 | $136 | $170 | $77 | 45% | 642 | $93 – $274 |
| 22 | Beaufort Memorial Hospital Beaufort, SC professional · percent of total billed charges · bothfrom % of charges | 1 | $114 | $114 | — | — | 596 | $114 – $114 |
| 23 | Saint Alphonsus Medical Center - Nampa Nampa, ID professional · fee schedule · both | 3 | $116 | $156 | $66 | 42% | 508 | $103 – $249 |
| 24 | Eisenhower Medical Center Rancho Mirage, CA fee schedule · inpatient | 8 | $207 | $223 | $28 | 13% | 499–562 | $207 – $272 |
| 25 | Mercy Health Hackley Campus Muskogen, MI professional · fee schedule · outpatient | 3 | $145 | $146 | $4 | 2% | 495 | $143 – $151 |
← Payers reporting CPT 99204 · Snapshot 20261112T181611Z-3fa9fb76