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 PERQ TCAT THER RX DLVR NTRAC RX BALO SEPARATE
Low
$45
Average
$11.8k
Median
$13.2k
High
$28.4k
Each hospital's average Tricare rate, under the methodology and billing class chosen below.
22 hospitals; the 90th percentile is 7.8× 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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22 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 | CentraState Medical Center Freehold Township, NJ other · outpatient | 2 | $13.2k | $13.2k | — | — | — | $13.2k – $13.2k |
| 2 | Charleston Area Medical Center Charleston, WV percent of total billed charges · bothfrom % of charges | 1 | $3.9k | $3.9k | $2.5k | 64% | — | $1.4k – $6.4k |
| 3 | Chilton Medical Center Pompton Plains, NJ other · outpatient | 2 | $13.2k | $13.2k | — | — | — | $13.2k – $13.2k |
| 4 | Hackettstown Medical Center Hackettstown, NJ other · outpatient | 2 | $13.2k | $13.2k | — | — | — | $13.2k – $13.2k |
| 5 | Hospital Service District #1, Parish of Terrebonne, State of Louisiana dba Terrebonne General Health System Houma, LA facility · fee schedule · outpatient | 1 | $9k | $9k | — | — | — | $9k – $9k |
| 6 | Kaweah Health Medical Center Visalia, CA facility · fee schedule · outpatient | 1 | $9.3k | $9.3k | — | — | — | $9.3k – $9.3k |
| 7 | Kaweah Health Mental Health Hospital Visalia, CA facility · fee schedule · outpatient | 1 | $9.3k | $9.3k | — | — | — | $9.3k – $9.3k |
| 8 | Morristown Medical Center Morristown, NJ other · outpatient | 2 | $13.2k | $13.2k | — | — | — | $13.2k – $13.2k |
| 9 | Newton Medical Center Newton, NJ other · outpatient | 2 | $13.2k | $13.2k | — | — | — | $13.2k – $13.2k |
| 10 | Northside Hospital, Inc. Lawrenceville, GA fee schedule · outpatient | 1 | $17.2k | $17.2k | — | — | — | $17.2k – $17.2k |
| 11 | Northside Hospital, Inc. Atlanta, GA fee schedule · outpatient | 1 | $17.2k | $17.2k | — | — | — | $17.2k – $17.2k |
| 12 | Northside Hospital, Inc. Cumming, GA fee schedule · outpatient | 1 | $17.2k | $17.2k | — | — | — | $17.2k – $17.2k |
| 13 | Northside Hospital, Inc. Duluth, GA fee schedule · outpatient | 1 | $17.2k | $17.2k | — | — | — | $17.2k – $17.2k |
| 14 | Northside Hospital, Inc. Canton, GA fee schedule · outpatient | 1 | $17.2k | $17.2k | — | — | — | $17.2k – $17.2k |
| 15 | Overlook Medical Center Summit, NJ other · outpatient | 2 | $13.2k | $13.2k | — | — | — | $13.2k – $13.2k |
| 16 | PRISMA HEALTH NORTH GREENVILLE LTACH HOSPITAL TRAVELERS REST, SC percent of total billed charges · bothfrom % of charges | 1 | $11.0k | $11.0k | — | — | — | $11.0k – $11.0k |
| 17 | Pennsylvania Hospital of the University of Pennsylvania Health System Philadelphia, PA facility · fee schedule · outpatient | 1 | $10.0k | $10.0k | — | — | — | $10.0k – $10.0k |
| 18 | The Toledo Hospital Maumee, OH facility · fee schedule · outpatient | 1 | $28.4k | $28.4k | — | — | — | $28.4k – $28.4k |
| 19 | The Trustees of the University of Pennsylvania D/B/A The Hospital of the University of Pennsylvania Philadelphia, PA facility · fee schedule · outpatient | 1 | $10.5k | $10.5k | — | — | — | $10.5k – $10.5k |
| 20 | University Health Truman Medical Center Kansas City, MO facility · fee schedule · outpatient | 1 | $2k | $2k | — | — | — | $2k – $2k |
| 21 | University of Virginia Medical Center Charlottesville, VA fee schedule · outpatient | 1 | $45 | $45 | — | — | — | $45 – $45 |
| 22 | University of Virginia Prince William Medical Center Manassas, VA fee schedule · outpatient | 1 | $670 | $670 | — | — | — | $670 – $670 |
← Payers reporting CPT 0914T · Snapshot 20261113T090226Z-3ce6c0b8