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
PR Visit Annual Well W/ Ppps Subsequent Visit
Low
$0
Average
$158
Median
$140
High
$1.4k
Each hospital's average Molina rate, under the methodology and billing class chosen below.
376 hospitals; the 90th percentile is 2.8× 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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496 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 | University of New Mexico Hospital | UNM Sandoval Regional Medical Center - A Campus of UNM Hospital Rio Rancho, NM facility · other · outpatient | 2 | $325 | $250 | $97 | 39% | 437–446 | $126 – $325 |
| 2 | Saint Alphonsus Regional Medical Center - Boise Boise, ID professional · fee schedule · both | 4 | $130 | $131 | $3 | 3% | 300–309 | $128 – $137 |
| 3 | Mercy Health Saint Marys Rockford, MI professional · fee schedule · outpatient | 3 | $110 | $124 | $20 | 16% | 32 | $110 – $152 |
| 4 | St Mary Mercy Livonia Livonia, MI professional · fee schedule · outpatient | 3 | $115 | $115 | $43 | 37% | 28 | $68 – $187 |
| 5 | North Canyon Medical Center Inc. Gooding, ID facility · percent of total billed charges · outpatientfrom % of charges | 1 | $149 | $149 | — | — | 15 | $149 – $149 |
| 6 | Brigham and Women's Hospital Boston, MA percent of total billed charges · bothfrom % of charges | 1 | $259 | $259 | $54 | 21% | 2–20 | $205 – $313 |
| 7 | Public Hospital District No 1 of Mason County Shelton, WA fee schedule · both | 1 | $334 | $334 | $8 | 2% | 2–20 | $326 – $342 |
| 8 | Beaufort Memorial Hospital Beaufort, SC professional · percent of total billed charges · bothfrom % of charges | 1 | $129 | $129 | — | — | 1–10 | $129 – $129 |
| 9 | Mercy Health Hackley Campus Muskogen, MI professional · fee schedule · outpatient | 3 | $110 | $124 | $20 | 16% | 1–10 | $110 – $152 |
| 10 | Mercy Health Lakeshore Campus Shelby, MI professional · fee schedule · outpatient | 3 | $165 | $173 | $31 | 18% | 1–10 | $130 – $227 |
| 11 | Mercy Health Saint Marys Rockford, MI professional · percent of total billed charges · bothfrom % of charges | 1 | $96 | $96 | — | — | 1–10 | $96 – $96 |
| 12 | Mount Carmel St Ann's Lewis Center, OH professional · percent of total billed charges · bothfrom % of charges | 1 | $285 | $285 | — | — | 1–10 | $285 – $285 |
| 13 | Nor-Lea Hospital District Lovington, NM professional · fee schedule · both | 1 | $273 | $273 | — | — | 1–10 | $273 – $273 |
| 14 | Valley County Hospital NE 68862-1240; 400 S 23rd St Ord, NE facility · percent of total billed charges · outpatientfrom % of charges | 2 | $35 | $35 | $0 | 1% | 1–10 | $35 – $35 |
| 15 | Valley County Hospital NE 68862-1240; 400 S 23rd St Ord, NE professional · other · both | 1 | $174 | $174 | — | — | 1–10 | $174 – $174 |
| 16 | AKRON GENERAL MEDICAL CENTER Akron, OH facility · case rate · outpatient | 1 | $60 | $60 | — | — | — | $60 – $60 |
| 17 | AMH Cath Labs LLC Arlington, TX case rate · outpatient | 1 | $140 | $140 | — | — | — | $140 – $140 |
| 18 | ARH Tug Valley Health Services, Inc. Paintsville, KY percent of total billed charges · outpatientfrom % of charges | 1 | $27 | $27 | — | — | — | $27 – $27 |
| 19 | ARTHUR G JAMES CANCER HOSPITAL AND RESEARCH INSTITUTE Columbus, OH per diem · inpatient | 2 | $5.4k | $5.4k | — | — | — | $5.4k – $5.4k |
| 20 | ARTHUR G JAMES CANCER HOSPITAL AND RESEARCH INSTITUTE Columbus, OH percent of total billed charges · inpatientfrom % of charges | 2 | $159 | $159 | $0 | 0% | — | $159 – $159 |
| 21 | ARTHUR G JAMES CANCER HOSPITAL AND RESEARCH INSTITUTE Columbus, OH percent of total billed charges · outpatientfrom % of charges | 4 | $120 | $124 | $15 | 12% | — | $110 – $146 |
| 22 | Adena Fayette Medical Center Washington Court House, OH facility · case rate · outpatient | 1 | $270 | $270 | — | — | — | $270 – $270 |
| 23 | Adena Health System Chillicothe, OH facility · fee schedule · outpatient | 2 | $201 | $201 | $69 | 34% | — | $132 – $270 |
| 24 | Advocate Childrens Hospital Oak Lawn Oak Lawn, IL facility · case rate · outpatient | 1 | $192 | $192 | — | — | — | $192 – $192 |
| 25 | Advocate Childrens Hospital Park Ridge Park Ridge, IL facility · case rate · outpatient | 1 | $192 | $192 | — | — | — | $192 – $192 |
← Payers reporting HCPCS G0439 · Snapshot 20261111T120946Z-9134e7f7