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
Hospice refer visit nonmd
Low
$0
Average
$121
Median
$86
High
$420
Each hospital's average Blue Cross Blue Shield rate, under the methodology and billing class chosen below.
35 hospitals; the 90th percentile is 3.2× 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 | Benson Hospital Corporation Benson, AZ facility · fee schedule · outpatient | 1 | $222 | $222 | — | — | — | $222 – $222 |
| 2 | Corewell Health Farmington Hills Hospital Farmington Hills, MI facility · fee schedule · outpatient | 2 | $267 | $267 | — | — | — | $267 – $267 |
| 3 | Covenant Medical Center Inc Saginaw, MI professional · fee schedule · both | 1 | $73 | $73 | — | — | — | $73 – $73 |
| 4 | Covenant Medical Center Inc Saginaw, MI professional · fee schedule · both | 1 | $73 | $73 | — | — | — | $73 – $73 |
| 5 | HonorHealth Florence Medical Center Florence, AZ facility · fee schedule · outpatient | 1 | $86 | $86 | $25 | 29% | — | $61 – $112 |
| 6 | Honorhealth Deer Valley Medical Center Phoenix, AZ facility · fee schedule · outpatient | 1 | $87 | $87 | $26 | 30% | — | $61 – $112 |
| 7 | Honorhealth Four Peaks Medical Center Mesa, AZ facility · fee schedule · outpatient | 1 | $86 | $86 | $25 | 29% | — | $61 – $112 |
| 8 | Honorhealth John C. Lincoln Medical Center Phoenix, AZ facility · fee schedule · outpatient | 1 | $87 | $87 | $26 | 30% | — | $61 – $112 |
| 9 | Honorhealth Scottsdale Osborn Medical Center Scottsdale, AZ facility · fee schedule · outpatient | 1 | $87 | $87 | $26 | 30% | — | $61 – $112 |
| 10 | Honorhealth Scottsdale Shea Medical Center Scottsdale, AZ facility · fee schedule · outpatient | 1 | $87 | $87 | $26 | 30% | — | $61 – $112 |
| 11 | Honorhealth Scottsdale Thompson Peak Med Center Scottsdale, AZ facility · fee schedule · outpatient | 1 | $87 | $87 | $26 | 30% | — | $61 – $112 |
| 12 | Honorhealth Sonoran Crossing Medical Center Phoenix, AZ facility · fee schedule · outpatient | 1 | $87 | $87 | $26 | 30% | — | $61 – $112 |
| 13 | Kalkaska Memorial Health Center Kalkaska, MI professional · fee schedule · both | 1 | $73 | $73 | — | — | — | $73 – $73 |
| 14 | LaSalle Parish Hospital Service District No. 1 Olla, LA facility · fee schedule · outpatient | 1 | $0 | $0 | — | — | — | $0 – $0 |
| 15 | Montefiore Medical Center Bronx, NY fee schedule · both | 7 | $524 | $510 | $90 | 18% | — | $321 – $616 |
| 16 | Montefiore Medical Center Bronx, NY percent of total billed charges · bothfrom % of charges | 3 | $210 | $210 | — | — | — | $210 – $210 |
| 17 | Munson Healthcare Cadillac Cadillac, MI professional · fee schedule · both | 1 | $73 | $73 | — | — | — | $73 – $73 |
| 18 | Munson Healthcare Charlevoix Hospital Charlevoix, MI professional · fee schedule · both | 1 | $73 | $73 | — | — | — | $73 – $73 |
| 19 | Munson Healthcare Grayling Grayling, MI professional · fee schedule · both | 1 | $73 | $73 | — | — | — | $73 – $73 |
| 20 | Munson Healthcare Manistee Hospital Manistee, MI professional · fee schedule · both | 1 | $73 | $73 | — | — | — | $73 – $73 |
| 21 | Munson Healthcare Otsego Memorial Hospital Gaylord, MI professional · fee schedule · both | 1 | $73 | $73 | — | — | — | $73 – $73 |
| 22 | Munson Medical Center Traverse City, MI professional · fee schedule · both | 1 | $73 | $73 | — | — | — | $73 – $73 |
| 23 | Oakwood Healthcare Inc Trenton, MI facility · fee schedule · outpatient | 2 | $185 | $185 | — | — | — | $185 – $185 |
| 24 | Oakwood Healthcare Inc Dearborn, MI facility · fee schedule · outpatient | 2 | $254 | $254 | — | — | — | $254 – $254 |
| 25 | Oakwood Healthcare Inc Taylor, MI facility · fee schedule · outpatient | 2 | $243 | $243 | — | — | — | $243 – $243 |
← Payers reporting HCPCS S0255 · Snapshot 20261113T090226Z-3ce6c0b8