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
$2
Average
$43
Median
$45
High
$143
Each hospital's average Molina rate, under the methodology and billing class chosen below.
35 hospitals; the 90th percentile is 13.8× 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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35 hospital rates
iThe hospitals that file a Molina 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 | AKRON GENERAL MEDICAL CENTER Akron, OH facility · case rate · outpatient | 1 | $46 | $46 | — | — | — | $46 – $46 |
| 2 | CLEVELAND CLINIC AVON HOSPITAL Avon, OH facility · case rate · outpatient | 1 | $44 | $44 | — | — | — | $44 – $44 |
| 3 | CLEVELAND CLINIC CHILDREN'S HOSPITAL FOR REHABILITATION Cleveland, OH facility · case rate · outpatient | 1 | $80 | $80 | — | — | — | $80 – $80 |
| 4 | CLEVELAND CLINIC HEALTH SYSTEM - EAST REGION Mentor, OH facility · case rate · outpatient | 1 | $49 | $49 | — | — | — | $49 – $49 |
| 5 | CLEVELAND CLINIC HEALTH SYSTEM - EAST REGION Euclid, OH facility · case rate · outpatient | 1 | $50 | $50 | — | — | — | $50 – $50 |
| 6 | CLEVELAND CLINIC HEALTH SYSTEM - EAST REGION Warrensville Heights, OH facility · case rate · outpatient | 1 | $52 | $52 | — | — | — | $52 – $52 |
| 7 | CLOVIS COMMUNITY MEDICAL CENTER Clovis, CA facility · fee schedule · outpatient | 1 | $17 | $17 | — | — | — | $17 – $17 |
| 8 | Cleveland Clinic Mercy Hospital Canton, OH facility · case rate · outpatient | 1 | $45 | $45 | — | — | — | $45 – $45 |
| 9 | FRESNO COMMUNITY HOSPITAL AND MEDICAL CENTER Fresno, CA facility · fee schedule · outpatient | 1 | $17 | $17 | — | — | — | $17 – $17 |
| 10 | Fairview Hospital Cleveland, OH facility · case rate · outpatient | 1 | $47 | $47 | — | — | — | $47 – $47 |
| 11 | Fisher-Titus Medical Center Norwalk, OH facility · case rate · outpatient | 1 | $33 | $33 | — | — | — | $33 – $33 |
| 12 | HCA HOUSTON HEALTHCARE CLEAR LAKE WEBSTER, TX percent of total billed charges · outpatientfrom % of charges | 1 | $6 | $6 | $1 | 9% | — | $5 – $6 |
| 13 | HCA HOUSTON HEALTHCARE CONROE CONROE, TX percent of total billed charges · outpatientfrom % of charges | 1 | $20 | $20 | — | — | — | $20 – $20 |
| 14 | HCA HOUSTON HEALTHCARE MEDICAL CENTER HOUSTON, TX percent of total billed charges · outpatientfrom % of charges | 1 | $59 | $72 | $51 | 70% | — | $13 – $162 |
| 15 | HCA HOUSTON HEALTHCARE NORTHWEST HOUSTON, TX percent of total billed charges · outpatientfrom % of charges | 1 | $40 | $53 | $49 | 91% | — | $9 – $156 |
| 16 | HCA HOUSTON HEALTHCARE PEARLAND HOUSTON, TX percent of total billed charges · outpatientfrom % of charges | 1 | $38 | $38 | $7 | 18% | — | $30 – $46 |
| 17 | HCA HOUSTON HEALTHCARE SOUTHEAST HOUSTON, TX percent of total billed charges · outpatientfrom % of charges | 1 | $43 | $55 | $29 | 53% | — | $26 – $94 |
| 18 | HCA HOUSTON HEALTHCARE TOMBALL Tomball, TX percent of total billed charges · outpatientfrom % of charges | 1 | $12 | $20 | $14 | 68% | — | $9 – $40 |
| 19 | HCA HOUSTON MAINLAND Texas City, TX percent of total billed charges · outpatientfrom % of charges | 1 | $5 | $5 | $1 | 11% | — | $5 – $6 |
| 20 | HCA Houston Rehabilitation Hospital Southeast Pasadena, TX percent of total billed charges · outpatientfrom % of charges | 1 | $43 | $55 | $29 | 53% | — | $26 – $94 |
| 21 | Kalkaska Memorial Health Center Kalkaska, MI facility · percent of total billed charges · outpatientfrom % of charges | 1 | $7 | $16 | $16 | 101% | — | $2 – $39 |
| 22 | Kirby Medical Center Monticello, IL professional · fee schedule · both | 1 | $2 | $2 | — | — | — | $2 – $2 |
| 23 | LODI COMMUNITY HOSPITAL Lodi, OH facility · case rate · outpatient | 1 | $77 | $77 | — | — | — | $77 – $77 |
| 24 | LUTHERAN HOSPITAL Cleveland, OH facility · case rate · outpatient | 1 | $45 | $45 | — | — | — | $45 – $45 |
| 25 | MARYMOUNT HOSPITAL INC Garfield Heights, OH facility · case rate · outpatient | 1 | $44 | $44 | — | — | — | $44 – $44 |
← Payers reporting HCPCS S0077 · Snapshot 20261112T181611Z-3fa9fb76