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
Current percep threshold tst
Low
$61
Average
$280
Median
$268
High
$613
Each hospital's average UnitedHealthcare rate, under the methodology and billing class chosen below.
72 hospitals; the 90th percentile is 3.0× 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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72 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 | AKRON GENERAL MEDICAL CENTER Akron, OH facility · case rate · outpatient | 1 | $344 | $344 | — | — | — | $344 – $344 |
| 2 | CHRISTUS Good Shepherd Hospital - Northpark Longview, TX fee schedule · outpatient | 2 | $191 | $191 | $49 | 26% | — | $142 – $240 |
| 3 | CHRISTUS Health - Pine Street Texarkana, TX fee schedule · outpatient | 2 | $256 | $256 | $15 | 6% | — | $241 – $270 |
| 4 | CHRISTUS Hospital - Orange Orange, TX fee schedule · outpatient | 2 | $217 | $217 | $39 | 18% | — | $178 – $256 |
| 5 | CHRISTUS West Beaumont Beaumont, TX fee schedule · outpatient | 2 | $217 | $217 | $39 | 18% | — | $178 – $256 |
| 6 | CLEVELAND CLINIC AVON HOSPITAL Avon, OH facility · case rate · outpatient | 1 | $340 | $340 | — | — | — | $340 – $340 |
| 7 | CLEVELAND CLINIC CHILDREN'S HOSPITAL FOR REHABILITATION Cleveland, OH facility · case rate · outpatient | 1 | $613 | $613 | — | — | — | $613 – $613 |
| 8 | CLEVELAND CLINIC HEALTH SYSTEM - EAST REGION Mentor, OH facility · case rate · outpatient | 1 | $377 | $377 | — | — | — | $377 – $377 |
| 9 | CLEVELAND CLINIC HEALTH SYSTEM - EAST REGION Euclid, OH facility · case rate · outpatient | 1 | $385 | $385 | — | — | — | $385 – $385 |
| 10 | CLEVELAND CLINIC HEALTH SYSTEM - EAST REGION Warrensville Heights, OH facility · case rate · outpatient | 1 | $401 | $401 | — | — | — | $401 – $401 |
| 11 | COMMUNITY MEMORIAL HOSPITAL Hill, VA case rate · outpatient | 1 | $204 | $204 | — | — | — | $204 – $204 |
| 12 | Central Louisiana Surgical Hospital Alexandria, LA fee schedule · outpatient | 1 | $128 | $128 | — | — | — | $128 – $128 |
| 13 | Christus Health Southeast Texas Beaumont, TX fee schedule · outpatient | 2 | $217 | $217 | $39 | 18% | — | $178 – $256 |
| 14 | Christus Health Southeast Texas Port Arthur, TX fee schedule · outpatient | 2 | $217 | $217 | $39 | 18% | — | $178 – $256 |
| 15 | Clallam County Public Hospital District 2 DBA Olympic Medical Center Port Angeles, WA case rate · outpatient | 1 | $130 | $130 | — | — | — | $130 – $130 |
| 16 | Cleveland Clinic Mercy Hospital Canton, OH facility · case rate · outpatient | 1 | $319 | $319 | — | — | — | $319 – $319 |
| 17 | Cleveland Clinic Weston Hospital Nonprofit Corporation Weston, FL facility · case rate · outpatient | 1 | $87 | $87 | — | — | — | $87 – $87 |
| 18 | Coushatta Health Care Center Coushatta, LA fee schedule · outpatient | 1 | $342 | $342 | — | — | — | $342 – $342 |
| 19 | Doctors’ Hospital of Williamsburg Williamsburg, VA fee schedule · outpatient | 1 | $181 | $181 | — | — | — | $181 – $181 |
| 20 | East Cooper Medical Center LLC Mt Pleasant, SC other · outpatient | 3 | $227 | $216 | $66 | 31% | — | $130 – $290 |
| 21 | Fairview Hospital Cleveland, OH facility · case rate · outpatient | 1 | $362 | $362 | — | — | — | $362 – $362 |
| 22 | Fisher-Titus Medical Center Norwalk, OH facility · case rate · outpatient | 1 | $249 | $249 | — | — | — | $249 – $249 |
| 23 | Good Shepherd Medical Center - Longview Longview, TX fee schedule · outpatient | 2 | $191 | $191 | $49 | 26% | — | $142 – $240 |
| 24 | Good Shepherd Medical Center - Marshall Marshall, TX fee schedule · outpatient | 2 | $191 | $191 | $49 | 26% | — | $142 – $240 |
| 25 | Gundersen Luthern Medical Center Inc La Crosse, WI facility · fee schedule · outpatient | 1 | $61 | $61 | — | — | — | $61 – $61 |
← Payers reporting HCPCS G0255 · Snapshot 20261112T124536Z-e251e855