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
$15
Average
$759
Median
$375
High
$4.1k
Each hospital's average Molina rate, under the methodology and billing class chosen below.
20 hospitals; the 90th percentile is 12.0× 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.
Filter by billing methodology
Filter by billing class
29 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 | Baptist Memorial Hospital-Collierville Collierville, TN facility · percent of total billed charges · inpatientfrom % of charges | 1 | $202 | $202 | $8 | 4% | — | $194 – $210 |
| 2 | Baptist Memorial Hospital-Collierville Collierville, TN facility · percent of total billed charges · outpatientfrom % of charges | 2 | $202 | $202 | $8 | 4% | — | $194 – $210 |
| 3 | Baptist Memorial Hospital-DeSoto Southaven, MS facility · percent of total billed charges · inpatientfrom % of charges | 1 | $194 | $194 | — | — | — | $194 – $194 |
| 4 | Baptist Memorial Hospital-DeSoto Southaven, MS facility · percent of total billed charges · outpatientfrom % of charges | 2 | $194 | $194 | — | — | — | $194 – $194 |
| 5 | Baptist Memorial Hospital-Golden Triangle Columbus, MS facility · percent of total billed charges · inpatientfrom % of charges | 1 | $367 | $367 | — | — | — | $367 – $367 |
| 6 | Baptist Memorial Hospital-Golden Triangle Columbus, MS facility · percent of total billed charges · outpatientfrom % of charges | 2 | $367 | $367 | — | — | — | $367 – $367 |
| 7 | Baptist Memorial Hospital-Memphis Memphis, TN facility · percent of total billed charges · inpatientfrom % of charges | 1 | $202 | $202 | $8 | 4% | — | $194 – $210 |
| 8 | Baptist Memorial Hospital-Memphis Memphis, TN facility · percent of total billed charges · outpatientfrom % of charges | 2 | $202 | $202 | $8 | 4% | — | $194 – $210 |
| 9 | Baptist Memorial Hospital-North Mississippi Oxford, MS facility · percent of total billed charges · inpatientfrom % of charges | 1 | $191 | $191 | — | — | — | $191 – $191 |
| 10 | Baptist Memorial Hospital-North Mississippi Oxford, MS facility · percent of total billed charges · outpatientfrom % of charges | 2 | $191 | $191 | — | — | — | $191 – $191 |
| 11 | Baptist Memorial Hospital-Tipton Covington, TN facility · percent of total billed charges · inpatientfrom % of charges | 1 | $194 | $194 | — | — | — | $194 – $194 |
| 12 | Baptist Memorial Hospital-Tipton Covington, TN facility · percent of total billed charges · outpatientfrom % of charges | 2 | $194 | $194 | — | — | — | $194 – $194 |
| 13 | Baptist Memorial Hospital-Women's Memphis, TN facility · percent of total billed charges · inpatientfrom % of charges | 1 | $202 | $202 | $8 | 4% | — | $194 – $210 |
| 14 | Baptist Memorial Hospital-Women's Memphis, TN facility · percent of total billed charges · outpatientfrom % of charges | 2 | $202 | $202 | $8 | 4% | — | $194 – $210 |
| 15 | Columbia Lutheran Charities Astoria, OR facility · percent of total billed charges · bothfrom % of charges | 2 | $13 | $15 | $6 | 38% | — | $9 – $26 |
| 16 | Columbia Lutheran Charities Astoria, OR professional · percent of total billed charges · bothfrom % of charges | 1 | $16 | $16 | — | — | — | $16 – $16 |
| 17 | Florida Coast Medical and Surgical Center, Inc. Port St. Lucie, FL fee schedule · outpatient | 1 | $20 | $20 | — | — | — | $20 – $20 |
| 18 | Gundersen Luthern Medical Center Inc La Crosse, WI facility · fee schedule · outpatient | 1 | $871 | $871 | — | — | — | $871 – $871 |
| 19 | Gundersen Palmer Lutheran Hospital and Clinic Inc West Union, IA facility · fee schedule · outpatient | 1 | $871 | $871 | — | — | — | $871 – $871 |
| 20 | HCA Healthcare Live Oak Mental Health and Wellness Ladson, SC case rate · outpatient | 1 | $1.6k | $1.6k | — | — | — | $1.6k – $1.6k |
| 21 | HCA Healthcare Summerville Hospital SUMMERVILLE, SC case rate · outpatient | 1 | $1.6k | $1.6k | — | — | — | $1.6k – $1.6k |
| 22 | HCA Healthcare Trident Hospital SUMMERVILLE, SC case rate · outpatient | 1 | $1.6k | $1.6k | — | — | — | $1.6k – $1.6k |
| 23 | Highland Hospital Rochester, NY fee schedule · outpatient | 2 | $384 | $384 | — | — | — | $384 – $384 |
| 24 | MEDICAL CITY FRISCO Frisco, TX percent of total billed charges · outpatientfrom % of charges | 1 | $4.1k | $4.1k | $2.1k | 50% | — | $2.1k – $6.2k |
| 25 | MEDICAL CITY MCKINNEY MCKINNEY, TX percent of total billed charges · outpatientfrom % of charges | 1 | $564 | $564 | $282 | 50% | — | $282 – $847 |
← Payers reporting HCPCS G0364 · Snapshot 20261112T124536Z-e251e855