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
$113
Average
$454
Median
$323
High
$1.1k
Each hospital's average Blue Cross Blue Shield rate, under the methodology and billing class chosen below.
36 hospitals; the 90th percentile is 7.5× 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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36 hospital rates
iThe hospitals that file a Blue Cross Blue Shield 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 | Advocate Childrens Hospital Oak Lawn Oak Lawn, IL facility · fee schedule · outpatient | 2 | $951 | $944 | $50 | 5% | — | $880 – $1.0k |
| 2 | Advocate Childrens Hospital Park Ridge Park Ridge, IL facility · fee schedule · outpatient | 2 | $965 | $957 | $51 | 5% | — | $892 – $1.0k |
| 3 | Advocate Christ Medical Center Oak Lawn, IL facility · fee schedule · outpatient | 2 | $933 | $927 | $49 | 5% | — | $864 – $983 |
| 4 | Advocate Condell Medical Center Libertyville, IL fee schedule · outpatient | 2 | $589 | $585 | $31 | 5% | — | $545 – $620 |
| 5 | Advocate Good Samaritan Hospital Downers Grove, IL fee schedule · outpatient | 2 | $956 | $949 | $50 | 5% | — | $884 – $1.0k |
| 6 | Advocate Good Shepherd Hospital Barrington, IL fee schedule · outpatient | 2 | $962 | $955 | $50 | 5% | — | $890 – $1.0k |
| 7 | Advocate Illinois Masonic Medical Center Chicago, IL fee schedule · outpatient | 2 | $962 | $955 | $50 | 5% | — | $890 – $1.0k |
| 8 | Advocate Lutheran General Hospital Park Ridge, IL fee schedule · outpatient | 2 | $946 | $940 | $49 | 5% | — | $876 – $997 |
| 9 | Advocate Sherman Hospital Elgin, IL fee schedule · outpatient | 2 | $450 | $446 | $23 | 5% | — | $416 – $473 |
| 10 | Advocate South Suburban Hospital Hazel Crest, IL fee schedule · outpatient | 2 | $959 | $952 | $50 | 5% | — | $888 – $1.0k |
| 11 | Advocate Trinity Hospital Chicago, IL fee schedule · outpatient | 2 | $956 | $949 | $50 | 5% | — | $884 – $1.0k |
| 12 | Keck Hospital of USC Los Angeles, CA facility · fee schedule · outpatient | 2 | $232 | $232 | $4 | 2% | — | $228 – $236 |
| 13 | Mission Hospital Regional Med Center Laguna Beach, CA fee schedule · outpatient | 2 | $132 | $132 | — | — | — | $132 – $132 |
| 14 | Newport Hospital Newport, RI facility · fee schedule · outpatient | 3 | $424 | $417 | $11 | 3% | — | $401 – $424 |
| 15 | NorCal HealthConnect LLC Petaluma, CA fee schedule · outpatient | 3 | $119 | $113 | $9 | 8% | — | $100 – $119 |
| 16 | NorCal HealthConnect LLC Healdsburg, CA fee schedule · outpatient | 1 | $254 | $254 | — | — | — | $254 – $254 |
| 17 | Providence Health System - Southern California Santa Monica, CA fee schedule · outpatient | 1 | $218 | $218 | — | — | — | $218 – $218 |
| 18 | Providence Health System - Southern California Burbank, CA fee schedule · outpatient | 1 | $278 | $278 | — | — | — | $278 – $278 |
| 19 | Providence Health System - Southern California Mission Hills, CA fee schedule · outpatient | 1 | $320 | $320 | — | — | — | $320 – $320 |
| 20 | Providence Health System - Southern California Torrance, CA fee schedule · outpatient | 1 | $327 | $327 | — | — | — | $327 – $327 |
| 21 | Providence Health System - Southern California San Pedro, CA fee schedule · outpatient | 1 | $340 | $340 | — | — | — | $340 – $340 |
| 22 | RESEARCH PSYCHIATRIC CENTER Kansas City, MO percent of total billed charges · outpatientfrom % of charges | 7 | $1.2k | $1.1k | $127 | 12% | — | $943 – $1.2k |
| 23 | Rady Children's Hospital - San Diego Murrieta, CA facility · fee schedule · outpatient | 2 | $311 | $311 | $12 | 4% | — | $299 – $323 |
| 24 | Rhode Island Hospital Providence, RI facility · fee schedule · outpatient | 4 | $413 | $379 | $65 | 17% | — | $267 – $424 |
| 25 | St Joseph Hospital of Orange Orange, CA fee schedule · outpatient | 2 | $130 | $130 | — | — | — | $130 – $130 |
← Payers reporting HCPCS Q3025 · Snapshot 20261113T090226Z-3ce6c0b8