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
CAST SUPPLIES UNLISTED
Low
$2
Average
$130
Median
$53
High
$535
Each hospital's average UnitedHealthcare rate, under the methodology and billing class chosen below.
78 hospitals; the 90th percentile is 18.3× 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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100 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 | Mount Graham Regional Medical Center Safford, AZ percent of total billed charges · inpatientfrom % of charges | 8 | $39 | $39 | — | — | 46–136 | $39 – $39 |
| 2 | Northern Hospital District of Surry County Mount Airy, NC facility · fee schedule · both | 1 | $14 | $14 | — | — | 7–70 | $14 – $14 |
| 3 | West Virginia University Hospitals, Inc. Morgantown, WV facility · percent of total billed charges · outpatientfrom % of charges | 1 | $99 | $99 | — | — | 3–30 | $99 – $99 |
| 4 | AKRON GENERAL MEDICAL CENTER Akron, OH facility · case rate · outpatient | 1 | $32 | $32 | — | — | — | $32 – $32 |
| 5 | ALICE_PECK_DAY_MEMORIAL_HOSPITAL LEBANON, NH percent of total billed charges · outpatientfrom % of charges | 2 | $97 | $87 | $15 | 18% | — | $65 – $98 |
| 6 | Benefis Hospitals Inc Helena, MT percent of total billed charges · bothfrom % of charges | 1 | $229 | $324 | $231 | 71% | — | $133 – $865 |
| 7 | Boston Children's Hospital Boston, MA percent of total billed charges · bothfrom % of charges | 2 | $215 | $215 | $36 | 17% | — | $179 – $251 |
| 8 | Boston Children's Hospital Lexington, MA percent of total billed charges · bothfrom % of charges | 2 | $215 | $215 | $36 | 17% | — | $179 – $251 |
| 9 | Boston Children's Hospital Brookline, MA percent of total billed charges · bothfrom % of charges | 2 | $215 | $215 | $36 | 17% | — | $179 – $251 |
| 10 | Boston Children's Hospital Dartmouth, MA percent of total billed charges · bothfrom % of charges | 2 | $215 | $215 | $36 | 17% | — | $179 – $251 |
| 11 | Boston Children's Hospital Boston, MA percent of total billed charges · bothfrom % of charges | 2 | $215 | $215 | $36 | 17% | — | $179 – $251 |
| 12 | Boston Children's Hospital Peabody, MA percent of total billed charges · bothfrom % of charges | 2 | $215 | $215 | $36 | 17% | — | $179 – $251 |
| 13 | Boston Children's Hospital Waltham, MA percent of total billed charges · bothfrom % of charges | 2 | $215 | $215 | $36 | 17% | — | $179 – $251 |
| 14 | Boston Children's Hospital Needham, MA percent of total billed charges · bothfrom % of charges | 2 | $215 | $215 | $36 | 17% | — | $179 – $251 |
| 15 | Boston Children's Hospital Weymouth, MA percent of total billed charges · bothfrom % of charges | 2 | $215 | $215 | $36 | 17% | — | $179 – $251 |
| 16 | CLEVELAND CLINIC AVON HOSPITAL Avon, OH facility · case rate · outpatient | 1 | $32 | $32 | — | — | — | $32 – $32 |
| 17 | CLEVELAND CLINIC CHILDREN'S HOSPITAL FOR REHABILITATION Cleveland, OH facility · case rate · outpatient | 1 | $57 | $57 | — | — | — | $57 – $57 |
| 18 | CLEVELAND CLINIC HEALTH SYSTEM - EAST REGION Mentor, OH facility · case rate · outpatient | 1 | $35 | $35 | — | — | — | $35 – $35 |
| 19 | CLEVELAND CLINIC HEALTH SYSTEM - EAST REGION Euclid, OH facility · case rate · outpatient | 1 | $36 | $36 | — | — | — | $36 – $36 |
| 20 | CLEVELAND CLINIC HEALTH SYSTEM - EAST REGION Warrensville Heights, OH facility · case rate · outpatient | 1 | $37 | $37 | — | — | — | $37 – $37 |
| 21 | COLUMBIA MEMORIAL HOSPITAL Hudson, NY professional · percent of total billed charges · outpatientfrom % of charges | 6 | $17 | $18 | $1 | 6% | — | $17 – $19 |
| 22 | Cleveland Clinic Mercy Hospital Canton, OH facility · case rate · outpatient | 1 | $30 | $30 | — | — | — | $30 – $30 |
| 23 | Conway Hospital, Inc. Conway, SC facility · percent of total billed charges · outpatientfrom % of charges | 1 | $26 | $26 | $9 | 33% | — | $17 – $34 |
| 24 | Deaconess Illinois Crossroads Inc Mount Vernon, IL professional · percent of total billed charges · bothfrom % of charges | 1 | $16 | $16 | — | — | — | $16 – $16 |
| 25 | Deaconess Regional Healthcare Services Illinois Inc Marion, IL professional · percent of total billed charges · bothfrom % of charges | 1 | $48 | $48 | — | — | — | $48 – $48 |
← Payers reporting HCPCS Q4050 · Snapshot 20261111T120946Z-9134e7f7