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
Lso sag ctr rigi pos pre ots
Low
$137
Average
$297
Median
$293
High
$413
Each hospital's average Carefirst rate, under the methodology and billing class chosen below.
9 hospitals; the 90th percentile is 2.3× 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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11 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 | $334 | $334 | — | — | — | $334 – $334 |
| 2 | MedStar Georgetown Hospital Washington, DC facility · fee schedule · outpatient | 1 | $110 | $110 | — | — | — | $110 – $110 |
| 3 | MedStar Georgetown Hospital Washington, DC facility · percent of total billed charges · outpatientfrom % of charges | 2 | $151 | $151 | — | — | — | $151 – $151 |
| 4 | MedStar Good Samaritan Hospital Baltimore, MD percent of total billed charges · outpatientfrom % of charges | 3 | $413 | $413 | — | — | — | $413 – $413 |
| 5 | MedStar Harbor Hospital Baltimore, MD percent of total billed charges · outpatientfrom % of charges | 3 | $274 | $274 | — | — | — | $274 – $274 |
| 6 | MedStar Montgomery Medical Center Olney, MD percent of total billed charges · outpatientfrom % of charges | 3 | $293 | $293 | — | — | — | $293 – $293 |
| 7 | MedStar Southern Hospital Center Clinton, MD percent of total billed charges · outpatientfrom % of charges | 3 | $386 | $386 | — | — | — | $386 – $386 |
| 8 | MedStar St. Mary's Hospital Leonardtown, MD percent of total billed charges · outpatientfrom % of charges | 3 | $395 | $395 | — | — | — | $395 – $395 |
| 9 | MedStar Union Memorial Hospital Baltimore, MD percent of total billed charges · outpatientfrom % of charges | 3 | $256 | $256 | — | — | — | $256 – $256 |
| 10 | MedStar Washington Hospital Center NW, WA facility · fee schedule · outpatient | 1 | $110 | $110 | — | — | — | $110 – $110 |
| 11 | MedStar Washington Hospital Center NW, WA facility · percent of total billed charges · outpatientfrom % of charges | 2 | $218 | $218 | — | — | — | $218 – $218 |
← Payers reporting HCPCS L0643 · Snapshot 20261112T181611Z-3fa9fb76