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
Remove unilat space maintain
Low
$60
Average
$995
Median
$893
High
$2.3k
Each hospital's average Molina rate, under the methodology and billing class chosen below.
129 hospitals; the 90th percentile is 16.4× 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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136 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 | $887 | $887 | — | — | — | $887 – $887 |
| 2 | ALLE-KISKI MEDICAL CENTER NATRONA HEIGHTS, PA fee schedule · outpatient | 1 | $1.7k | $1.7k | — | — | — | $1.7k – $1.7k |
| 3 | Baptist Medical Center of Nassau, INC Yulee, FL facility · case rate · outpatient | 1 | $103 | $103 | — | — | — | $103 – $103 |
| 4 | Baptist Medical Center of the Beaches, INC Beach, FL facility · case rate · outpatient | 1 | $103 | $103 | — | — | — | $103 – $103 |
| 5 | Beaufort Memorial Hospital Beaufort, SC facility · case rate · outpatient | 1 | $207 | $207 | — | — | — | $207 – $207 |
| 6 | CANONSBURG GENERAL HOSPITAL CANONSBURG, PA fee schedule · outpatient | 1 | $1.7k | $1.7k | — | — | — | $1.7k – $1.7k |
| 7 | CHRISTUS Health - Pine Street Texarkana, TX fee schedule · outpatient | 1 | $1.6k | $1.6k | — | — | — | $1.6k – $1.6k |
| 8 | CHRISTUS Hospital - Orange Orange, TX fee schedule · outpatient | 1 | $1.7k | $1.7k | — | — | — | $1.7k – $1.7k |
| 9 | CHRISTUS West Beaumont Beaumont, TX fee schedule · outpatient | 1 | $1.7k | $1.7k | — | — | — | $1.7k – $1.7k |
| 10 | CLEVELAND CLINIC AVON HOSPITAL Avon, OH facility · case rate · outpatient | 1 | $861 | $861 | — | — | — | $861 – $861 |
| 11 | CLEVELAND CLINIC CHILDREN'S HOSPITAL FOR REHABILITATION Cleveland, OH facility · case rate · outpatient | 1 | $1.6k | $1.6k | — | — | — | $1.6k – $1.6k |
| 12 | CLEVELAND CLINIC HEALTH SYSTEM - EAST REGION Mentor, OH facility · case rate · outpatient | 1 | $954 | $954 | — | — | — | $954 – $954 |
| 13 | CLEVELAND CLINIC HEALTH SYSTEM - EAST REGION Euclid, OH facility · case rate · outpatient | 1 | $975 | $975 | — | — | — | $975 – $975 |
| 14 | CLEVELAND CLINIC HEALTH SYSTEM - EAST REGION Warrensville Heights, OH facility · case rate · outpatient | 1 | $1.0k | $1.0k | — | — | — | $1.0k – $1.0k |
| 15 | COMMUNITY MEMORIAL HOSPITAL Hill, VA case rate · outpatient | 1 | $213 | $213 | — | — | — | $213 – $213 |
| 16 | Christus Health Southeast Texas Beaumont, TX fee schedule · outpatient | 1 | $1.7k | $1.7k | — | — | — | $1.7k – $1.7k |
| 17 | Christus Health Southeast Texas Port Arthur, TX fee schedule · outpatient | 1 | $1.7k | $1.7k | — | — | — | $1.7k – $1.7k |
| 18 | Clallam County Public Hospital District 2 DBA Olympic Medical Center Port Angeles, WA case rate · outpatient | 1 | $97 | $97 | — | — | — | $97 – $97 |
| 19 | Clallam County Public Hospital District 2 DBA Olympic Medical Center Port Angeles, WA fee schedule · outpatient | 1 | $1.0k | $1.0k | — | — | — | $1.0k – $1.0k |
| 20 | Cleveland Clinic Mercy Hospital Canton, OH facility · case rate · outpatient | 1 | $866 | $866 | — | — | — | $866 – $866 |
| 21 | Conway Hospital, Inc. Conway, SC facility · fee schedule · outpatient | 2 | $1.5k | $1.5k | — | — | — | $1.5k – $1.5k |
| 22 | ERIE COUNTY MEDICAL CENTER CORPORATION Buffalo, NY fee schedule · outpatient | 3 | $76 | $107 | $45 | 42% | — | $76 – $170 |
| 23 | East Cooper Medical Center LLC Mt Pleasant, SC fee schedule · outpatient | 3 | $613 | $699 | $122 | 17% | — | $613 – $872 |
| 24 | Fairview Hospital Cleveland, OH facility · case rate · outpatient | 1 | $916 | $916 | — | — | — | $916 – $916 |
| 25 | Fisher-Titus Medical Center Norwalk, OH facility · case rate · outpatient | 1 | $642 | $642 | — | — | — | $642 – $642 |
← Payers reporting HCPCS D1520 · Snapshot 20261112T124536Z-e251e855