Reported by 9 hospitals in the network under the other methodology.
Filter by billing methodology
Reflects a payer-specific billing methodology not covered by the standard categories.
Low
$18
Average
$63
Median
$21
High
$195
| # | Hospital | Location | Approximate number of payer billing records behind this hospital’s price. CMS privacy rules cap small counts as a range (e.g. “1–10”) rather than an exact number — more samples means a more reliable price. | |||||
|---|---|---|---|---|---|---|---|---|
| 1 | Sonora Community Hospital | Sonora, CA | $16 | $18 | $5 | — | $10 | $115 |
| 2 | Glendale Adventist Medical Center | Glendale, CA | $21 | $43 | $50 | — | $2 | $240 |
| 3 | Simi Valley Hospital And Health Care Services | Valley, CA | $16 | $21 | $7 | — | $12 | $103 |
| 4 | Rideout Memorial Hospital | Marysville, CA | $16 | $19 | $5 | — | $1 | $54 |
| 5 | Lodi Memorial Hospital Association Inc | Lodi, CA | $16 | $19 | $5 | — | $2 | $105 |
| 6 | Sierra Vista Hospital Inc | Obispo, CA | $16 | $36 | $40 | — | $16 | $3.0k |
| 7 | White Memorial Medical Center | Angeles, CA | $16 | $20 | $13 | — | $2 | $106 |
| 8 | Nebraska Medical Center | Omaha, NE | $221 | $195 | $141 | — | $5 | $764 |
| 9 | Bellevue Medical Center Llc | Bellevue, NE | $221 | $195 | $141 | — | $5 | $764 |
Ask Claude or any MCP client for HCPCS 86904 pricing at a specific hospital — see how to connect.