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
INSJ/RPLC CAR MODULJ PLS GN
Puyallup, WA
See all hospitals reporting CPT 0409T →Price type
Good Samaritan Hospital’s median price of $42.9k is 90% above the median hospital's median price ($22.5k), higher than 92% of the 1,319 hospitals reporting CPT 0409T. The highlighted bar is where this hospital falls; shaded is the middle 50% of hospitals.
Negotiated rates from the hospital’s own file: 9 payers, 13 plan rates. A facility fee, a professional fee, a per diem and a case rate are different bills, so each is listed on its own. Open a payer to see it across hospitals.
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| # | ||||
|---|---|---|---|---|
| 1 | Aetna medadvantage fee schedule · outpatient | $26,204 | $26,204 | $26,204 – $26,204 |
| 2 | Regence medadvantage fee schedule · outpatient | $26,204 | $26,204 | $26,204 – $26,204 |
| 3 | UnitedHealthcare medadvantage fee schedule · outpatient | $26,458 | $26,458 | $26,458 – $26,458 |
| 4 | Molina medadvantage fee schedule · outpatient | $26,712 | $26,712 | $26,712 – $26,712 |
| 5 | WellCare medadvantage fee schedule · outpatient | $26,712 | $26,712 | $26,712 – $26,712 |
| 6 | Premera hmo fee schedule · outpatient | $42,747 | $42,747 | $42,747 – $42,747 |
| 7 | Ambetter coordinated care exchange fee schedule · outpatient | $50,881 | $50,881 | $50,881 – $50,881 |
| 8 | Premera signature fee schedule · outpatient | $86,124 | $86,124 | $86,124 – $86,124 |
| 9 | Premera prime fee schedule · outpatient | $88,062 | $88,062 | $88,062 – $88,062 |
| 10 | Aetna all commercial plans fee schedule · outpatient | $104,718 | $104,718 | $104,718 – $104,718 |
| 11 | Kaiser ppo fee schedule · outpatient | $105,649 | $105,649 | $105,649 – $105,649 |
| 12 | Cigna all commercial plans fee schedule · outpatient | $106,774 | $106,774 | $106,774 – $106,774 |
| 13 | Premera other commercial plans fee schedule · outpatient | $108,230 | $108,230 | $108,230 – $108,230 |
Last updated: Aug 27, 2026
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