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
$6
Average
$50
Median
$44
High
$87
Each hospital's average Optum rate, under the methodology and billing class chosen below.
16 hospitals; the 90th percentile is 3.9× 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.
Filter by billing methodology
Filter by billing class
17 hospital rates
iThe hospitals that file a Optum 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 | ACADIA GENERAL HOSPITAL, INC 1305 CROWLEY RAYNE HWY other · outpatient | 1 | $87 | $87 | — | — | — | $87 – $87 |
| 2 | AKRON GENERAL MEDICAL CENTER Akron, OH facility · case rate · outpatient | 1 | $41 | $41 | — | — | — | $41 – $41 |
| 3 | CLEVELAND CLINIC CHILDREN'S HOSPITAL FOR REHABILITATION Cleveland, OH facility · case rate · outpatient | 1 | $73 | $73 | — | — | — | $73 – $73 |
| 4 | CLEVELAND CLINIC HEALTH SYSTEM - EAST REGION Mentor, OH facility · case rate · outpatient | 1 | $45 | $45 | — | — | — | $45 – $45 |
| 5 | CLEVELAND CLINIC HEALTH SYSTEM - EAST REGION Euclid, OH facility · case rate · outpatient | 1 | $46 | $46 | — | — | — | $46 – $46 |
| 6 | CLEVELAND CLINIC HEALTH SYSTEM - EAST REGION Warrensville Heights, OH facility · case rate · outpatient | 1 | $47 | $47 | — | — | — | $47 – $47 |
| 7 | Fairview Hospital Cleveland, OH facility · case rate · outpatient | 1 | $43 | $43 | — | — | — | $43 – $43 |
| 8 | LAFAYETTE GENERAL MEDICAL CENTER INC Lafayette, LA other · outpatient | 1 | $87 | $87 | — | — | — | $87 – $87 |
| 9 | LODI COMMUNITY HOSPITAL Lodi, OH facility · case rate · outpatient | 1 | $70 | $70 | — | — | — | $70 – $70 |
| 10 | LUTHERAN HOSPITAL Cleveland, OH facility · case rate · outpatient | 1 | $41 | $41 | — | — | — | $41 – $41 |
| 11 | MARYMOUNT HOSPITAL INC Garfield Heights, OH facility · case rate · outpatient | 1 | $40 | $40 | — | — | — | $40 – $40 |
| 12 | MEDICAL CITY FORT WORTH FORT WORTH, TX percent of total billed charges · outpatientfrom % of charges | 1 | $62 | $83 | $43 | 52% | — | $33 – $150 |
| 13 | MEDINA HOSPITAL Medina, OH facility · case rate · outpatient | 1 | $42 | $42 | — | — | — | $42 – $42 |
| 14 | ST. DAVID'S NORTH AUSTIN MEDICAL CENTER AUSTIN, TX percent of total billed charges · outpatientfrom % of charges | 1 | $21 | $21 | $3 | 12% | — | $18 – $25 |
| 15 | The Cleveland Clinic Foundation Brunswick, OH facility · case rate · outpatient | 1 | $52 | $52 | — | — | — | $52 – $52 |
| 16 | The Cleveland Clinic Foundation Brunswick, OH professional · percent of total billed charges · outpatientfrom % of charges | 3 | $12 | $12 | $1 | 11% | — | $10 – $13 |
| 17 | The Trustees of the University of Pennsylvania D/B/A The Hospital of the University of Pennsylvania Philadelphia, PA facility · other · outpatient | 3 | $8 | $6 | $3 | 52% | — | $2 – $8 |
← Payers reporting HCPCS S0077 · Snapshot 20261112T181611Z-3fa9fb76