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
PR INTER ICD SBSTRNL PROF EA 90DAYS
Low
$29
Average
$123
Median
$164
High
$199
Each hospital's average Tricare rate, under the methodology and billing class chosen below.
9 hospitals; the 90th percentile is 3.0× 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
11 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 | CORNING HOSPITAL Corning, NY facility · other · outpatient | 2 | $164 | $164 | — | — | — | $164 – $164 |
| 2 | Catholic Health Initiatives-Iowa Corp Des Moines, IA professional · percent of total billed charges · inpatientfrom % of charges | 1 | $48 | $48 | — | — | — | $48 – $48 |
| 3 | Catholic Health Initiatives-Iowa Corp Des Moines, IA professional · percent of total billed charges · outpatientfrom % of charges | 1 | $78 | $78 | — | — | — | $78 – $78 |
| 4 | GUTHRIE CORTLAND MEDICAL CENTER Cortland, NY facility · other · outpatient | 1 | $164 | $164 | — | — | — | $164 – $164 |
| 5 | Holy Cross Hospital-Ft. Lauderdale Ft. Lauderdale, FL professional · percent of total billed charges · inpatientfrom % of charges | 1 | $94 | $94 | — | — | — | $94 – $94 |
| 6 | Holy Cross Hospital-Ft. Lauderdale Ft. Lauderdale, FL professional · percent of total billed charges · outpatientfrom % of charges | 1 | $44 | $44 | — | — | — | $44 – $44 |
| 7 | Mayo Clinic Health System Sparta, WI professional · percent of total billed charges · outpatientfrom % of charges | 1 | $91 | $91 | — | — | — | $91 – $91 |
| 8 | ROBERT PACKER HOSPITAL Sayre, PA facility · other · outpatient | 2 | $164 | $164 | — | — | — | $164 – $164 |
| 9 | ROBERT PACKER HOSPITAL Doing Business As: ROBERT PACKER HOSPITAL, TOWANDA CAMPUS Towanda, PA facility · other · outpatient | 2 | $164 | $164 | — | — | — | $164 – $164 |
| 10 | TROY COMMUNITY HOSPITAL INCORPORATED Troy, PA facility · percent of total billed charges · outpatientfrom % of charges | 1 | $29 | $29 | — | — | — | $29 – $29 |
| 11 | The Trustees of the University of Pennsylvania D/B/A The Hospital of the University of Pennsylvania Philadelphia, PA facility · fee schedule · outpatient | 1 | $199 | $199 | — | — | — | $199 – $199 |
← Payers reporting CPT 0578T · Snapshot 20261113T090226Z-3ce6c0b8