APC 5721
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.
Generation details were not recorded for this description.
Original text from hospital filings
Level 1 Diagnostic Tests and Related Services
Low
$126
Average
$240
Median
$156
High
$1.3k
Each hospital's average Tricare rate, under the methodology and billing class chosen below.
28 hospitals; the 90th percentile is 1.9× 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.
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28 hospital rates
iThe hospitals that file a Tricare 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 | Aspirus Langlade Hospital Antigo, WI other · outpatient | 1 | $1.3k | $1.3k | — | — | 1–10 | $1.3k – $1.3k |
| 2 | Aspirus Medford Hospital Medford, WI other · outpatient | 1 | $1.2k | $1.2k | — | — | 1–10 | $1.2k – $1.2k |
| 3 | Aspirus Merrill Hospital Merrill, WI other · outpatient | 1 | $279 | $279 | — | — | 1–10 | $279 – $279 |
| 4 | Aspirus Plover Hospital Stevens Point, WI other · outpatient | 1 | $149 | $149 | — | — | 1–10 | $149 – $149 |
| 5 | Aspirus Rhinelander Hospital Rhinelander, WI other · outpatient | 1 | $159 | $159 | — | — | 1–10 | $159 – $159 |
| 6 | Aspirus Wausau Hospital Wausau, WI other · outpatient | 1 | $149 | $149 | — | — | 1–10 | $149 – $149 |
| 7 | CORNING HOSPITAL Corning, NY facility · fee schedule · outpatient | 1 | $156 | $156 | — | — | — | $156 – $156 |
| 8 | Canton-Potsdam Hospital Potsdam, NY facility · other · outpatient | 1 | $198 | $198 | — | — | 1–10 | $198 – $198 |
| 9 | El Camino Hospital Los Gatos, CA other · outpatient | 2 | $253 | $253 | $29 | 12% | 2–20 | $224 – $282 |
| 10 | GUTHRIE CORTLAND MEDICAL CENTER Cortland, NY facility · fee schedule · outpatient | 1 | $156 | $156 | — | — | — | $156 – $156 |
| 11 | Howard Young Medical Center Woodruff, WI other · outpatient | 1 | $159 | $159 | — | — | 1–10 | $159 – $159 |
| 12 | Logan Health Medical Center Kalispell, MT other · outpatient | 1 | $126 | $126 | — | — | 1–10 | $126 – $126 |
| 13 | McLeod Health Dillon, SC case rate · outpatient | 1 | $137 | $137 | — | — | — | $137 – $137 |
| 14 | McLeod Health Cheraw, SC case rate · outpatient | 1 | $137 | $137 | — | — | — | $137 – $137 |
| 15 | McLeod Health Manning, SC case rate · outpatient | 1 | $137 | $137 | — | — | — | $137 – $137 |
| 16 | McLeod Health Florence, SC case rate · outpatient | 1 | $137 | $137 | — | — | — | $137 – $137 |
| 17 | McLeod Health Beach, SC case rate · outpatient | 1 | $137 | $137 | — | — | — | $137 – $137 |
| 18 | McLeod Health Loris, SC case rate · outpatient | 1 | $137 | $137 | — | — | — | $137 – $137 |
| 19 | McLeod Health River, SC case rate · outpatient | 1 | $137 | $137 | — | — | — | $137 – $137 |
| 20 | Metrohealth System Parma, OH facility · other · outpatient | 1 | $145 | $145 | — | — | 1–10 | $145 – $145 |
| 21 | OUR LADY OF LOURDES MEMORIAL HOSPITAL INC. Doing Business As: LOURDES Binghamton, NY facility · fee schedule · outpatient | 1 | $156 | $156 | — | — | — | $156 – $156 |
| 22 | ROBERT PACKER HOSPITAL Sayre, PA facility · fee schedule · outpatient | 1 | $156 | $156 | — | — | — | $156 – $156 |
| 23 | ROBERT PACKER HOSPITAL Doing Business As: ROBERT PACKER HOSPITAL, TOWANDA CAMPUS Towanda, PA facility · fee schedule · outpatient | 1 | $156 | $156 | — | — | — | $156 – $156 |
| 24 | The Unity Hospital of Rochester Rochester, NY facility · other · outpatient | 1 | $185 | $185 | — | — | 23 | $185 – $185 |
| 25 | Thibodaux Regional Medical Center Thibodaux, LA other · outpatient | 1 | $144 | $144 | — | — | 18 | $144 – $144 |
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