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
Dispense fee initial 30 day
Low
$0
Average
$85
Median
$5
High
$255
Each hospital's average Blue Cross Blue Shield rate, under the methodology and billing class chosen below.
40 hospitals; the 90th percentile is 122.1× 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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41 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 | Advocate Childrens Hospital Oak Lawn Oak Lawn, IL facility · fee schedule · outpatient | 2 | $253 | $251 | $13 | 5% | — | $234 – $267 |
| 2 | Advocate Childrens Hospital Park Ridge Park Ridge, IL facility · fee schedule · outpatient | 2 | $257 | $255 | $14 | 5% | — | $238 – $270 |
| 3 | Advocate Christ Medical Center Oak Lawn, IL facility · fee schedule · outpatient | 2 | $249 | $247 | $13 | 5% | — | $230 – $262 |
| 4 | Advocate Condell Medical Center Libertyville, IL fee schedule · outpatient | 2 | $157 | $156 | $8 | 5% | — | $145 – $165 |
| 5 | Advocate Good Samaritan Hospital Downers Grove, IL fee schedule · outpatient | 2 | $255 | $253 | $13 | 5% | — | $235 – $268 |
| 6 | Advocate Good Shepherd Hospital Barrington, IL fee schedule · outpatient | 2 | $256 | $254 | $13 | 5% | — | $237 – $270 |
| 7 | Advocate Illinois Masonic Medical Center Chicago, IL fee schedule · outpatient | 2 | $256 | $254 | $13 | 5% | — | $237 – $270 |
| 8 | Advocate Lutheran General Hospital Park Ridge, IL fee schedule · outpatient | 2 | $252 | $250 | $13 | 5% | — | $233 – $265 |
| 9 | Advocate Sherman Hospital Elgin, IL fee schedule · outpatient | 2 | $120 | $119 | $6 | 5% | — | $111 – $126 |
| 10 | Advocate South Suburban Hospital Hazel Crest, IL fee schedule · outpatient | 2 | $256 | $254 | $13 | 5% | — | $236 – $269 |
| 11 | Advocate Trinity Hospital Chicago, IL fee schedule · outpatient | 2 | $255 | $253 | $13 | 5% | — | $235 – $268 |
| 12 | Benson Hospital Corporation Benson, AZ facility · fee schedule · outpatient | 1 | $8 | $8 | — | — | — | $8 – $8 |
| 13 | Edward Hospital Plainfield, IL fee schedule · outpatient | 1 | $125 | $125 | — | — | — | $125 – $125 |
| 14 | Elmhurst Memorial Hospital Elmhurst, IL fee schedule · outpatient | 1 | $125 | $125 | — | — | — | $125 – $125 |
| 15 | Endeavor Health Clinical Operations Skokie, IL fee schedule · outpatient | 3 | $199 | $200 | $13 | 7% | — | $184 – $216 |
| 16 | HonorHealth Florence Medical Center Florence, AZ facility · fee schedule · outpatient | 1 | $4 | $4 | $0 | 1% | — | $4 – $4 |
| 17 | Honorhealth Deer Valley Medical Center Phoenix, AZ facility · fee schedule · outpatient | 1 | $4 | $4 | — | — | — | $4 – $4 |
| 18 | Honorhealth Four Peaks Medical Center Mesa, AZ facility · fee schedule · outpatient | 1 | $4 | $4 | $0 | 1% | — | $4 – $4 |
| 19 | Honorhealth John C. Lincoln Medical Center Phoenix, AZ facility · fee schedule · outpatient | 1 | $4 | $4 | — | — | — | $4 – $4 |
| 20 | Honorhealth Scottsdale Osborn Medical Center Scottsdale, AZ facility · fee schedule · outpatient | 1 | $4 | $4 | — | — | — | $4 – $4 |
| 21 | Honorhealth Scottsdale Shea Medical Center Scottsdale, AZ facility · fee schedule · outpatient | 1 | $4 | $4 | — | — | — | $4 – $4 |
| 22 | Honorhealth Scottsdale Thompson Peak Med Center Scottsdale, AZ facility · fee schedule · outpatient | 1 | $4 | $4 | — | — | — | $4 – $4 |
| 23 | Honorhealth Sonoran Crossing Medical Center Phoenix, AZ facility · fee schedule · outpatient | 1 | $4 | $4 | — | — | — | $4 – $4 |
| 24 | Kalkaska Memorial Health Center Kalkaska, MI professional · fee schedule · both | 1 | $2 | $2 | — | — | — | $2 – $2 |
| 25 | Munson Healthcare Cadillac Cadillac, MI professional · fee schedule · both | 1 | $2 | $2 | — | — | — | $2 – $2 |
← Payers reporting HCPCS G0333 · Snapshot 20261112T124536Z-e251e855