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
$90
Average
$207
Median
$177
High
$558
Each hospital's average Premera rate, under the methodology and billing class chosen below.
40 hospitals; the 90th percentile is 2.1× 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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62 hospital rates
iThe hospitals that file a Premera 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 | Saint Francis Hospital and Medical Center Hartford, CT professional · fee schedule · both | 1 | $226 | $226 | — | — | 1–10 | $226 – $226 |
| 2 | Central Community Hospital Elkader, IA professional · fee schedule · inpatient | 1 | $139 | $139 | $46 | 33% | — | $93 – $185 |
| 3 | Central Community Hospital Elkader, IA professional · fee schedule · outpatient | 1 | $210 | $210 | $25 | 12% | — | $185 – $235 |
| 4 | Central Washington Health Services Association Wenatchee, WA fee schedule · both | 4 | $440 | $409 | $75 | 18% | — | $226 – $440 |
| 5 | Columbia Lutheran Charities Astoria, OR facility · percent of total billed charges · bothfrom % of charges | 1 | $119 | $153 | $54 | 35% | — | $111 – $230 |
| 6 | Covenant Medical Center Inc Waterloo, IA professional · fee schedule · both | 1 | $185 | $185 | — | — | — | $185 – $185 |
| 7 | Good Samaritan Hospital Puyallup, WA fee schedule · outpatient | 4 | $234 | $241 | $28 | 12% | — | $210 – $286 |
| 8 | Holy Cross Hospital-Ft. Lauderdale Ft. Lauderdale, FL facility · per diem · both | 1 | $763 | $763 | — | — | — | $763 – $763 |
| 9 | Holy Cross Hospital-Ft. Lauderdale Ft. Lauderdale, FL facility · per diem · outpatient | 1 | $763 | $763 | — | — | — | $763 – $763 |
| 10 | Holy Cross Hospital-Ft. Lauderdale Ft. Lauderdale, FL professional · fee schedule · both | 1 | $148 | $148 | — | — | — | $148 – $148 |
| 11 | Mary Bridge Children's Hospital Tacoma, WA fee schedule · outpatient | 4 | $234 | $241 | $28 | 12% | — | $210 – $286 |
| 12 | Mercy Fitzgerald Hospital Darby, PA professional · fee schedule · inpatient | 1 | $109 | $109 | $36 | 33% | — | $73 – $145 |
| 13 | Mercy Fitzgerald Hospital Darby, PA professional · fee schedule · outpatient | 1 | $164 | $164 | $19 | 12% | — | $145 – $183 |
| 14 | Mercy Health Hackley Campus Muskogen, MI facility · percent of total billed charges · bothfrom % of charges | 1 | $130 | $130 | — | — | — | $130 – $130 |
| 15 | Mercy Health Hackley Campus Muskogen, MI professional · fee schedule · inpatient | 1 | $208 | $208 | — | — | — | $208 – $208 |
| 16 | Mercy Health Hackley Campus Muskogen, MI professional · fee schedule · outpatient | 1 | $177 | $177 | — | — | — | $177 – $177 |
| 17 | Mercy Health Lakeshore Campus Shelby, MI facility · percent of total billed charges · bothfrom % of charges | 1 | $227 | $227 | — | — | — | $227 – $227 |
| 18 | Mercy Health Lakeshore Campus Shelby, MI professional · fee schedule · inpatient | 1 | $156 | $156 | $52 | 33% | — | $104 – $208 |
| 19 | Mercy Health Lakeshore Campus Shelby, MI professional · fee schedule · outpatient | 1 | $236 | $236 | $28 | 12% | — | $208 – $264 |
| 20 | Mercy Health Saint Marys Rockford, MI facility · percent of total billed charges · bothfrom % of charges | 1 | $129 | $129 | — | — | — | $129 – $129 |
| 21 | Mercy Health Saint Marys Rockford, MI professional · fee schedule · inpatient | 1 | $208 | $208 | — | — | — | $208 – $208 |
| 22 | Mercy Health Saint Marys Rockford, MI professional · fee schedule · outpatient | 1 | $177 | $177 | — | — | — | $177 – $177 |
| 23 | Mercy Health Services-Iowa Corp. Mason City, IA professional · fee schedule · both | 1 | $185 | $185 | — | — | — | $185 – $185 |
| 24 | Mercy Medical Center - New Hampton New Hampton, IA professional · fee schedule · inpatient | 1 | $139 | $139 | $46 | 33% | — | $93 – $185 |
| 25 | Mercy Medical Center - New Hampton New Hampton, IA professional · fee schedule · outpatient | 1 | $196 | $196 | $39 | 20% | — | $157 – $235 |
← Payers reporting HCPCS G0439 · Snapshot 20261111T120946Z-9134e7f7