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
$17
Average
$67
Median
$77
High
$130
Each hospital's average UnitedHealthcare rate, under the methodology and billing class chosen below.
18 hospitals; the 90th percentile is 3.0× 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.
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20 hospital rates
iThe hospitals that file a UnitedHealthcare 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 | $93 | $93 | — | — | — | $93 – $93 |
| 2 | BELLEVUE MEDICAL CENTER LLC Bellevue, NE percent of total billed charges · outpatientfrom % of charges | 1 | $37 | $37 | — | — | — | $37 – $37 |
| 3 | Butler Healthcare Providers_ DBA Butler Memorial Hospital Butler, PA facility · case rate · outpatient | 1 | $31 | $31 | — | — | — | $31 – $31 |
| 4 | COMMUNITY MEMORIAL HOSPITAL Hill, VA case rate · outpatient | 1 | $88 | $88 | — | — | — | $88 – $88 |
| 5 | Cheshire Medical Center Keene, NH professional · fee schedule · outpatient | 4 | $73 | $76 | $37 | 49% | — | $39 – $120 |
| 6 | Cleveland Clinic Weston Hospital Nonprofit Corporation Weston, FL facility · case rate · outpatient | 1 | $36 | $36 | — | — | — | $36 – $36 |
| 7 | Deaconess Illinois Crossroads Inc Mount Vernon, IL professional · percent of total billed charges · bothfrom % of charges | 1 | $17 | $17 | — | — | — | $17 – $17 |
| 8 | Deaconess Regional Healthcare Services Illinois Inc Marion, IL professional · percent of total billed charges · bothfrom % of charges | 1 | $53 | $53 | — | — | — | $53 – $53 |
| 9 | Doctors’ Hospital of Williamsburg Williamsburg, VA fee schedule · outpatient | 1 | $79 | $79 | — | — | — | $79 – $79 |
| 10 | Gundersen Luthern Medical Center Inc La Crosse, WI facility · fee schedule · outpatient | 1 | $25 | $25 | — | — | — | $25 – $25 |
| 11 | Mary Hitchcock Memorial Hospital Lebanon, NH professional · fee schedule · outpatient | 1 | $130 | $130 | — | — | — | $130 – $130 |
| 12 | Nebraska Medical Center Omaha, NE fee schedule · outpatient | 1 | $93 | $93 | — | — | — | $93 – $93 |
| 13 | Nebraska Medical Center Omaha, NE percent of total billed charges · outpatientfrom % of charges | 1 | $37 | $37 | — | — | — | $37 – $37 |
| 14 | Riverside Hospital Inc Newport News, VA fee schedule · outpatient | 1 | $79 | $79 | — | — | — | $79 – $79 |
| 15 | Riverside Middle Peninsula Hospital, Inc Gloucester, VA fee schedule · outpatient | 1 | $79 | $79 | — | — | — | $79 – $79 |
| 16 | SHORE HEALTH SERVICES INC. Onancock, VA fee schedule · outpatient | 1 | $79 | $79 | — | — | — | $79 – $79 |
| 17 | South Shore Hospital South Weymouth, MA fee schedule · outpatient | 1 | $86 | $86 | — | — | — | $86 – $86 |
| 18 | University of Florida Health Gainesville, FL facility · case rate · outpatient | 2 | $40 | $40 | — | — | — | $40 – $40 |
| 19 | VCU HEALTH TAPPAHANNOCK HOSPITAL Tappahannock, VA case rate · outpatient | 1 | $87 | $87 | — | — | — | $87 – $87 |
| 20 | VIRGINIA COMMONWEALTH UNIVERSITY HEALTH SYSTEM AUTHORITY Richmond, VA case rate · outpatient | 1 | $87 | $87 | — | — | — | $87 – $87 |
← Payers reporting HCPCS G2065 · Snapshot 20261112T181611Z-3fa9fb76