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
Prgrmg Dev Eval Scrms Phys/Qhp Remote
Low
$34
Average
$90
Median
$37
High
$392
Each hospital's average Tricare rate, under the methodology and billing class chosen below.
37 hospitals; the 90th percentile is 11.6× 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.
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44 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 | Ascension Providence Waco, TX other · inpatient | 1 | $37 | $37 | — | — | — | $37 – $37 |
| 2 | Ascension Providence Waco, TX other · outpatient | 1 | $37 | $37 | — | — | — | $37 – $37 |
| 3 | Ascension Seton Austin, TX other · inpatient | 1 | $36 | $36 | — | — | — | $36 – $36 |
| 4 | Ascension Seton Austin, TX other · inpatient | 1 | $36 | $36 | — | — | — | $36 – $36 |
| 5 | Ascension Seton Bastrop, TX other · inpatient | 1 | $36 | $36 | — | — | — | $36 – $36 |
| 6 | Ascension Seton Austin, TX other · inpatient | 1 | $36 | $36 | — | — | — | $36 – $36 |
| 7 | CLAIBORNE MEDICAL CENTER Tazewell, TN fee schedule · outpatient | 1 | $36 | $36 | — | — | — | $36 – $36 |
| 8 | CUMBERLAND MEDICAL CENTER, INC. Crossville, TN fee schedule · outpatient | 1 | $36 | $36 | — | — | — | $36 – $36 |
| 9 | Conway Regional Medical Center Conway, AR facility · fee schedule · outpatient | 1 | $96 | $96 | — | — | — | $96 – $96 |
| 10 | FORT LOUDOUN MEDICAL CENTER Lenoir City, TN fee schedule · outpatient | 1 | $34 | $34 | — | — | — | $34 – $34 |
| 11 | FORT SANDERS REGIONAL MEDICAL CENTER Knoxville, TN fee schedule · outpatient | 1 | $34 | $34 | — | — | — | $34 – $34 |
| 12 | Henry Ford Health Township, MI other · inpatient | 1 | $37 | $37 | — | — | — | $37 – $37 |
| 13 | Henry Ford Health Township, MI other · outpatient | 1 | $37 | $37 | — | — | — | $37 – $37 |
| 14 | Henry Ford Health Detroit, MI other · inpatient | 1 | $37 | $37 | — | — | — | $37 – $37 |
| 15 | Henry Ford Health Detroit, MI other · outpatient | 1 | $37 | $37 | — | — | — | $37 – $37 |
| 16 | Henry Ford Health Warren, MI other · inpatient | 1 | $37 | $37 | — | — | — | $37 – $37 |
| 17 | Henry Ford Health Warren, MI other · outpatient | 1 | $37 | $37 | — | — | — | $37 – $37 |
| 18 | Kaleida Health Buffalo, NY fee schedule · outpatient | 1 | $44 | $44 | — | — | — | $44 – $44 |
| 19 | Kaweah Health Medical Center Visalia, CA facility · fee schedule · outpatient | 1 | $94 | $94 | — | — | — | $94 – $94 |
| 20 | Kaweah Health Mental Health Hospital Visalia, CA facility · fee schedule · outpatient | 1 | $94 | $94 | — | — | — | $94 – $94 |
| 21 | LECONTE MEDICAL CENTER Sevierville, TN fee schedule · outpatient | 1 | $36 | $36 | — | — | — | $36 – $36 |
| 22 | Little Company of Mary Hospital of Indiana Inc Jasper, IN facility · case rate · outpatient | 1 | $33 | $33 | — | — | — | $33 – $33 |
| 23 | Little Company of Mary Hospital of Indiana Inc Jasper, IN professional · fee schedule · both | 1 | $59 | $59 | — | — | — | $59 – $59 |
| 24 | METHODIST MEDICAL CENTER OF OAK RIDGE Oak Ridge, TN fee schedule · outpatient | 1 | $34 | $34 | — | — | — | $34 – $34 |
| 25 | MORRISTOWN HAMBLEN HOSPITAL ASSOCIATION Morristown, TN fee schedule · outpatient | 1 | $34 | $34 | — | — | — | $34 – $34 |
← Payers reporting CPT 0650T · Snapshot 20261113T090226Z-3ce6c0b8