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
Fee Schedule
Low
$1
Average
$16
Median
$6
High
$85
Each hospital's average Blue Cross Blue Shield rate, under the methodology and billing class chosen below.
31 hospitals; the 90th percentile is 48.3× 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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31 hospital rates
iThe hospitals that file a Blue Cross Blue Shield 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 | ALBANY MEDICAL CENTER HOSPITAL Albany, NY facility · case rate · outpatient | 4 | $62 | $80 | $29 | 37% | — | $51 – $116 |
| 2 | Billings Clinic Billings, MT fee schedule · outpatient | 1 | $4 | $4 | — | — | — | $4 – $4 |
| 3 | COLUMBIA MEMORIAL HOSPITAL Hudson, NY facility · case rate · outpatient | 3 | $95 | $81 | $21 | 26% | — | $51 – $95 |
| 4 | Covenant Medical Center Lubbock, TX fee schedule · outpatient | 4 | $1 | $1 | $0 | 1% | — | $1 – $1 |
| 5 | GLENS FALLS HOSPITAL INC Falls, NY facility · case rate · outpatient | 1 | $60 | $60 | — | — | — | $60 – $60 |
| 6 | Keck Hospital of USC Los Angeles, CA facility · fee schedule · outpatient | 2 | $10 | $10 | $0 | 2% | — | $10 – $10 |
| 7 | Lubbock Heritage Hospital LLC Lubbock, TX fee schedule · outpatient | 4 | $1 | $1 | $0 | 1% | — | $1 – $1 |
| 8 | Methodist Children's Hospital Lubbock, TX fee schedule · outpatient | 4 | $1 | $1 | $0 | 1% | — | $1 – $1 |
| 9 | Methodist Hospital Levelland Levelland, TX fee schedule · outpatient | 4 | $1 | $1 | — | — | — | $1 – $1 |
| 10 | Methodist Hospital Plainview Plainview, TX fee schedule · outpatient | 4 | $1 | $1 | — | — | — | $1 – $1 |
| 11 | Mission Hospital Regional Med Center Laguna Beach, CA fee schedule · outpatient | 2 | $6 | $6 | — | — | — | $6 – $6 |
| 12 | NorCal HealthConnect LLC Petaluma, CA fee schedule · outpatient | 3 | $5 | $5 | $0 | 8% | — | $4 – $5 |
| 13 | NorCal HealthConnect LLC Healdsburg, CA fee schedule · outpatient | 1 | $11 | $11 | — | — | — | $11 – $11 |
| 14 | Providence Health System - Southern California Santa Monica, CA fee schedule · outpatient | 1 | $9 | $9 | — | — | — | $9 – $9 |
| 15 | Providence Health System - Southern California Burbank, CA fee schedule · outpatient | 1 | $12 | $12 | — | — | — | $12 – $12 |
| 16 | Providence Health System - Southern California Mission Hills, CA fee schedule · outpatient | 1 | $13 | $13 | — | — | — | $13 – $13 |
| 17 | Providence Health System - Southern California Torrance, CA fee schedule · outpatient | 1 | $14 | $14 | — | — | — | $14 – $14 |
| 18 | Providence Health System - Southern California San Pedro, CA fee schedule · outpatient | 1 | $14 | $14 | — | — | — | $14 – $14 |
| 19 | Rady Children's Hospital - San Diego Murrieta, CA facility · fee schedule · outpatient | 2 | $13 | $13 | $1 | 4% | — | $13 – $14 |
| 20 | Saratoga Hospital Saratoga Springs, NY facility · case rate · outpatient | 3 | $100 | $85 | $22 | 26% | — | $54 – $100 |
| 21 | St Joseph Hospital of Orange Orange, CA fee schedule · outpatient | 2 | $5 | $5 | — | — | — | $5 – $5 |
| 22 | St Joseph Health Northern California LLC Fortuna, CA fee schedule · outpatient | 2 | $5 | $5 | — | — | — | $5 – $5 |
| 23 | St Joseph Health Northern California LLC Santa Rosa, CA fee schedule · outpatient | 3 | $5 | $5 | $0 | 8% | — | $5 – $5 |
| 24 | St Joseph Health Northern California LLC Eureka, CA fee schedule · outpatient | 2 | $5 | $5 | — | — | — | $5 – $5 |
| 25 | St Joseph Health Northern California LLC Napa, CA fee schedule · outpatient | 3 | $5 | $5 | $0 | 8% | — | $5 – $5 |
← Payers reporting HCPCS C9039 · Snapshot 20261113T090226Z-3ce6c0b8