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
$73
Average
$313
Median
$252
High
$1.4k
Each hospital's average Molina rate, under the methodology and billing class chosen below.
22 hospitals; the 90th percentile is 4.5× 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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33 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 | BELLEVUE MEDICAL CENTER LLC Bellevue, NE fee schedule · outpatient | 1 | $715 | $715 | — | — | — | $715 – $715 |
| 2 | BELLEVUE MEDICAL CENTER LLC Bellevue, NE percent of total billed charges · outpatientfrom % of charges | 1 | $312 | $312 | — | — | — | $312 – $312 |
| 3 | Baptist Memorial Hospital-Collierville Collierville, TN facility · percent of total billed charges · inpatientfrom % of charges | 1 | $252 | $252 | — | — | — | $252 – $252 |
| 4 | Baptist Memorial Hospital-Collierville Collierville, TN facility · percent of total billed charges · outpatientfrom % of charges | 2 | $252 | $252 | — | — | — | $252 – $252 |
| 5 | Baptist Memorial Hospital-DeSoto Southaven, MS facility · percent of total billed charges · inpatientfrom % of charges | 1 | $220 | $220 | — | — | — | $220 – $220 |
| 6 | Baptist Memorial Hospital-DeSoto Southaven, MS facility · percent of total billed charges · outpatientfrom % of charges | 2 | $220 | $220 | — | — | — | $220 – $220 |
| 7 | Baptist Memorial Hospital-Golden Triangle Columbus, MS facility · percent of total billed charges · inpatientfrom % of charges | 1 | $309 | $309 | — | — | — | $309 – $309 |
| 8 | Baptist Memorial Hospital-Golden Triangle Columbus, MS facility · percent of total billed charges · outpatientfrom % of charges | 2 | $309 | $309 | — | — | — | $309 – $309 |
| 9 | Baptist Memorial Hospital-Memphis Memphis, TN facility · percent of total billed charges · inpatientfrom % of charges | 1 | $252 | $252 | — | — | — | $252 – $252 |
| 10 | Baptist Memorial Hospital-Memphis Memphis, TN facility · percent of total billed charges · outpatientfrom % of charges | 2 | $252 | $252 | — | — | — | $252 – $252 |
| 11 | Baptist Memorial Hospital-Women's Memphis, TN facility · percent of total billed charges · inpatientfrom % of charges | 1 | $252 | $252 | — | — | — | $252 – $252 |
| 12 | Baptist Memorial Hospital-Women's Memphis, TN facility · percent of total billed charges · outpatientfrom % of charges | 2 | $252 | $252 | — | — | — | $252 – $252 |
| 13 | Carle BroMenn Medical Center Normal, IL percent of total billed charges · inpatientfrom % of charges | 2 | $296 | $296 | — | — | — | $296 – $296 |
| 14 | Carle BroMenn Medical Center Normal, IL percent of total billed charges · outpatientfrom % of charges | 2 | $296 | $296 | — | — | — | $296 – $296 |
| 15 | Carle Eureka Hospital Eureka, IL percent of total billed charges · inpatientfrom % of charges | 2 | $296 | $296 | — | — | — | $296 – $296 |
| 16 | Carle Eureka Hospital Eureka, IL percent of total billed charges · outpatientfrom % of charges | 2 | $503 | $503 | $207 | 41% | — | $296 – $709 |
| 17 | Centinela Hospital Medical Center Inglewood, CA fee schedule · outpatient | 2 | $141 | $141 | — | — | — | $141 – $141 |
| 18 | Florida Coast Medical and Surgical Center, Inc. Port St. Lucie, FL fee schedule · outpatient | 1 | $268 | $268 | — | — | — | $268 – $268 |
| 19 | Gottlieb Memorial Hospital Melrose Park, IL facility · case rate · outpatient | 1 | $163 | $163 | — | — | — | $163 – $163 |
| 20 | Gundersen Luthern Medical Center Inc La Crosse, WI facility · fee schedule · outpatient | 1 | $73 | $73 | — | — | — | $73 – $73 |
| 21 | Gundersen Palmer Lutheran Hospital and Clinic Inc West Union, IA facility · fee schedule · outpatient | 1 | $73 | $73 | — | — | — | $73 – $73 |
| 22 | Loyola University Medical Center Maywood, IL facility · case rate · outpatient | 1 | $235 | $235 | — | — | — | $235 – $235 |
| 23 | MacNeal Hospital Berwyn, IL facility · case rate · outpatient | 1 | $163 | $163 | — | — | — | $163 – $163 |
| 24 | Mississippi Baptist Medical Center Jackson, MS facility · percent of total billed charges · inpatientfrom % of charges | 1 | $452 | $452 | — | — | — | $452 – $452 |
| 25 | Mississippi Baptist Medical Center Jackson, MS facility · percent of total billed charges · outpatientfrom % of charges | 1 | $452 | $452 | — | — | — | $452 – $452 |
← Payers reporting HCPCS G0365 · Snapshot 20261112T181611Z-3fa9fb76