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
facility
Low
$25
Average
$1.5k
Median
$45
High
$11.0k
Each hospital's average Carefirst rate, under the methodology and billing class chosen below.
17 hospitals; the 90th percentile is 217.9× 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 Carefirst 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 | MedStar Franklin Square Medical Center Baltimore, MD percent of total billed charges · outpatientfrom % of charges | 3 | $25 | $25 | — | — | — | $25 – $25 |
| 2 | MedStar Georgetown Hospital Washington, DC facility · fee schedule · outpatient | 3 | $48 | $38 | $14 | 36% | — | $18 – $48 |
| 3 | MedStar Good Samaritan Hospital Baltimore, MD percent of total billed charges · outpatientfrom % of charges | 3 | $73 | $73 | — | — | — | $73 – $73 |
| 4 | MedStar Harbor Hospital Baltimore, MD percent of total billed charges · outpatientfrom % of charges | 3 | $60 | $60 | — | — | — | $60 – $60 |
| 5 | MedStar Montgomery Medical Center Olney, MD percent of total billed charges · outpatientfrom % of charges | 3 | $33 | $33 | — | — | — | $33 – $33 |
| 6 | MedStar Southern Hospital Center Clinton, MD percent of total billed charges · outpatientfrom % of charges | 3 | $47 | $47 | — | — | — | $47 – $47 |
| 7 | MedStar St. Mary's Hospital Leonardtown, MD percent of total billed charges · outpatientfrom % of charges | 3 | $30 | $30 | — | — | — | $30 – $30 |
| 8 | MedStar Union Memorial Hospital Baltimore, MD percent of total billed charges · outpatientfrom % of charges | 3 | $59 | $59 | — | — | — | $59 – $59 |
| 9 | MedStar Washington Hospital Center NW, WA facility · fee schedule · outpatient | 3 | $59 | $45 | $19 | 42% | — | $18 – $59 |
| 10 | Mishawaka Medical Center Mishawaka, IN facility · fee schedule · both | 1 | $11.0k | $11.0k | — | — | — | $11.0k – $11.0k |
| 11 | National Rehabilitation Hospital Washington, WA facility · fee schedule · outpatient | 1 | $18 | $18 | — | — | — | $18 – $18 |
| 12 | National Rehabilitation Hospital Washington, WA facility · percent of total billed charges · inpatientfrom % of charges | 2 | $38 | $38 | $5 | 13% | — | $33 – $43 |
| 13 | National Rehabilitation Hospital Washington, WA facility · percent of total billed charges · outpatientfrom % of charges | 1 | $41 | $41 | — | — | — | $41 – $41 |
| 14 | Potomac Hospital Corporation of Prince William Lake Ridge, VA facility · fee schedule · outpatient | 2 | $25 | $25 | $2 | 6% | — | $24 – $27 |
| 15 | RESTON HOSPITAL CENTER Reston, VA fee schedule · outpatient | 2 | $28 | $28 | — | — | — | $28 – $28 |
| 16 | STONESPRINGS HOSPITAL CENTER Dulles, VA fee schedule · outpatient | 2 | $28 | $28 | — | — | — | $28 – $28 |
| 17 | Saint Marys Hospital Waterbury, CT facility · fee schedule · both | 1 | $6.3k | $6.3k | — | — | — | $6.3k – $6.3k |
| 18 | St Joseph Mercy Livingston Hospital | Trinity Health Medical Center - Brighton Brighton, MI facility · fee schedule · both | 1 | $5.6k | $5.6k | — | — | — | $5.6k – $5.6k |
| 19 | UPMC Hanover Hanover, PA facility · percent of total billed charges · inpatientfrom % of charges | 1 | $2.2k | $2.2k | — | — | — | $2.2k – $2.2k |
| 20 | UPMC Hanover Hanover, PA facility · percent of total billed charges · outpatientfrom % of charges | 1 | $2.2k | $2.2k | — | — | — | $2.2k – $2.2k |
← Payers reporting HCPCS J0491 · Snapshot 20261111T120946Z-9134e7f7