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
Dispensing Fee, Bicros
Low
$14
Average
$262
Median
$200
High
$826
Each hospital's average Anthem rate, under the methodology and billing class chosen below.
89 hospitals; the 90th percentile is 16.6× 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
114 hospital rates
iThe hospitals that file a Anthem 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 | University of Wisconsin Hospital and Clinics Authority WI 53718; 1675 Highland Ave Madison, WI percent of total billed chargesfrom % of charges | 4 | $577 | $594 | $180 | 30% | 1–10 | $367 – $855 |
| 2 | AKRON GENERAL MEDICAL CENTER Akron, OH facility · case rate · outpatient | 1 | $35 | $35 | — | — | — | $35 – $35 |
| 3 | Blue Hill Memorial Hospital Hill, ME professional · fee schedule · outpatient | 2 | $150 | $150 | — | — | — | $150 – $150 |
| 4 | CLEVELAND CLINIC AVON HOSPITAL Avon, OH facility · case rate · outpatient | 1 | $34 | $34 | — | — | — | $34 – $34 |
| 5 | CLEVELAND CLINIC CHILDREN'S HOSPITAL FOR REHABILITATION Cleveland, OH facility · case rate · outpatient | 1 | $61 | $61 | — | — | — | $61 – $61 |
| 6 | CLEVELAND CLINIC HEALTH SYSTEM - EAST REGION Mentor, OH facility · case rate · outpatient | 1 | $38 | $38 | — | — | — | $38 – $38 |
| 7 | CLEVELAND CLINIC HEALTH SYSTEM - EAST REGION Euclid, OH facility · case rate · outpatient | 1 | $39 | $39 | — | — | — | $39 – $39 |
| 8 | CLEVELAND CLINIC HEALTH SYSTEM - EAST REGION Warrensville Heights, OH facility · case rate · outpatient | 1 | $40 | $40 | — | — | — | $40 – $40 |
| 9 | COMMUNITY MEMORIAL HOSPITAL Hill, VA case rate · outpatient | 1 | $49 | $49 | — | — | — | $49 – $49 |
| 10 | Carmel AmbSurg Carmel, IN fee schedule · outpatient | 8 | $150 | $150 | — | — | — | $150 – $150 |
| 11 | Charles A. Dean Memorial Hospital Greenville, ME professional · fee schedule · outpatient | 2 | $150 | $150 | — | — | — | $150 – $150 |
| 12 | Cheshire Medical Center Keene, NH professional · percent of total billed charges · inpatientfrom % of charges | 2 | $253 | $253 | — | — | — | $253 – $253 |
| 13 | Cheshire Medical Center Keene, NH professional · percent of total billed charges · outpatientfrom % of charges | 1 | $253 | $253 | — | — | — | $253 – $253 |
| 14 | Children's Hospital Medical Center Mason, OH percent of total billed charges · inpatientfrom % of charges | 2 | $826 | $826 | $14 | 2% | — | $812 – $840 |
| 15 | Children's Hospital Medical Center Mason, OH percent of total billed charges · outpatientfrom % of charges | 2 | $826 | $826 | $14 | 2% | — | $812 – $840 |
| 16 | Cleveland Clinic Mercy Hospital Canton, OH facility · case rate · outpatient | 1 | $34 | $34 | — | — | — | $34 – $34 |
| 17 | Deaconess Health System Gibson General Hospital Princeton, IN professional · fee schedule · both | 2 | $75 | $75 | $75 | 100% | — | $0 – $150 |
| 18 | Deaconess Health System Henderson Hospital Henderson, KY professional · fee schedule · both | 5 | $150 | $129 | $52 | 41% | — | $0 – $150 |
| 19 | Deaconess Health System Union County Hospital Morganfield, KY professional · fee schedule · both | 5 | $150 | $107 | $68 | 63% | — | $0 – $150 |
| 20 | Deaconess Hospital, Inc Newburgh, IN professional · fee schedule · both | 3 | $75 | $75 | $75 | 100% | — | $0 – $150 |
| 21 | Deaconess Hospital, Inc Newburgh, IN professional · fee schedule · both | 4 | $75 | $75 | $75 | 100% | — | $0 – $150 |
| 22 | Doctors’ Hospital of Williamsburg Williamsburg, VA fee schedule · outpatient | 1 | $44 | $44 | — | — | — | $44 – $44 |
| 23 | Eastern Maine Medical Center Bangor, ME professional · fee schedule · outpatient | 2 | $150 | $150 | — | — | — | $150 – $150 |
| 24 | Endo Surgery Center Carmel, IN fee schedule · outpatient | 8 | $150 | $150 | — | — | — | $150 – $150 |
| 25 | Fairview Hospital Cleveland, OH facility · case rate · outpatient | 1 | $36 | $36 | — | — | — | $36 – $36 |
← Payers reporting HCPCS V5240 · Snapshot 20261111T120946Z-9134e7f7