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
Noonan Spectrum Sequence Level 5
Ozark, MO
See all hospitals reporting CPT 81404 →Price type
Mercy Hospital Springfield’s median price of $528 is 70% above the median hospital's median price ($311), higher than 76% of the 2,098 hospitals reporting CPT 81404. The highlighted bar is where this hospital falls; shaded is the middle 50% of hospitals.
Negotiated rates from the hospital’s own file: 13 payers, 27 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 | Blue Cross Blue Shield hb sprg anthem pathways exchange facility · fee schedule · outpatient | $209 | $209 | — | — | — | $209 – $209 |
| 2 | Aetna hb sprg ok medicaid facility · fee schedule · outpatient | $244 | $244 | — | — | — | $244 – $244 |
| 3 | Humana hb sprg ok medicaid facility · fee schedule · outpatient | $244 | $244 | — | — | — | $244 – $244 |
| 4 | Medicaid hb sprg ok medicaid facility · fee schedule · outpatient | $244 | $244 | — | — | — | $244 – $244 |
| 5 | Medicaid hb sprg mo medicaid facility · fee schedule · outpatient | $247 | $247 | — | — | — | $247 – $247 |
| 6 | Anthem hb sprg anthem alliance facility · fee schedule · outpatient | $249 | $249 | — | — | — | $249 – $249 |
| 7 | Blue Cross Blue Shield hb sprg anthem alliance facility · fee schedule · outpatient | $249 | $249 | — | — | — | $249 – $249 |
| 8 | Medica hb sprg lebn medica exchange facility · fee schedule · outpatient | $260 | $260 | — | — | — | $260 – $260 |
| 9 | Optum hb sprg uhc all payer facility · fee schedule · outpatient | $275 | $275 | — | — | — | $275 – $275 |
| 10 | UnitedHealthcare hb sprg uhc all payer facility · fee schedule · outpatient | $275 | $275 | — | — | — | $275 – $275 |
| 11 | UnitedHealthcare hb sprg uhc individual exchange facility · fee schedule · outpatient | $275 | $275 | — | — | — | $275 – $275 |
| 12 | UnitedHealthcare hb sprg uhc options ppo facility · fee schedule · outpatient | $275 | $275 | — | — | — | $275 – $275 |
| 13 | WellCare hb sprg & lebn wellcare mcr 103% facility · fee schedule · outpatient | $278 | $278 | — | — | — | $278 – $278 |
| 14 | Anthem hb sprg anthem blue access facility · fee schedule · outpatient | $313 | $313 | — | — | — | $313 – $313 |
| 15 | Blue Cross Blue Shield hb sprg anthem blue access facility · fee schedule · outpatient | $313 | $313 | — | — | — | $313 – $313 |
| 16 | Aetna hb sprg aetna commercial facility · fee schedule · outpatient | $330 | $330 | — | — | — | $330 – $330 |
| 17 | Medicaid hb sprg/jopl ark medicaid facility · fee schedule · outpatient | $352 | $352 | — | — | — | $352 – $352 |
| 18 | Blue Cross Blue Shield hb sprg missouri care plan/healthy blue facility · fee schedule · outpatient | $408 | $408 | — | — | — | $408 – $408 |
| 19 | UnitedHealthcare hb sprg uhc mo medicaid facility · fee schedule · outpatient | $421 | $421 | — | — | — | $421 – $421 |
| 20 | Ambetter hb sprg ambetter exchange mo facility · fee schedule · outpatient | $528 | $528 | — | — | — | $528 – $528 |
| 21 | First Health hb sprg aetna first health-network access facility · percent of total billed charges · outpatientfrom % of charges | $474 | $590 | $208 | 35% | — | $414 – $881 |
| 22 | Humana hb sprg humana facility · percent of total billed charges · outpatientfrom % of charges | $575 | $716 | $252 | 35% | — | $503 – $1.1k |
| 23 | Blue Cross Blue Shield hb sprg anthem blue preferred facility · percent of total billed charges · outpatientfrom % of charges | $617 | $768 | $270 | 35% | — | $540 – $1.1k |
| 24 | Blue Cross Blue Shield hb sprg anthem traditional facility · percent of total billed charges · outpatientfrom % of charges | $646 | $805 | $283 | 35% | — | $565 – $1.2k |
| 25 | MultiPlan hb sprg phcs (mpi) facility · percent of total billed charges · outpatientfrom % of charges | $651 | $811 | $285 | 35% | — | $570 – $1.2k |
Last updated: Jun 4, 2026
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