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
Xcapsl Ctrc Rmvl Insj Io Lens Prosth Insj 1+
Low
$313
Average
$11.4k
Median
$4.8k
High
$50k
Each hospital's average Tricare rate, under the methodology and billing class chosen below.
75 hospitals; the 90th percentile is 28.7× 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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77 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 | LAFAYETTE GENERAL MEDICAL CENTER INC Lafayette, LA other · outpatient | 1 | $4.7k | $4.7k | — | — | 1–10 | $4.7k – $4.7k |
| 2 | ACADIA GENERAL HOSPITAL, INC 1305 CROWLEY RAYNE HWY other · outpatient | 1 | $4.7k | $4.7k | — | — | — | $4.7k – $4.7k |
| 3 | Anderson Hospital Maryville, IL facility · fee schedule · outpatient | 1 | $50k | $50k | — | — | — | $50k – $50k |
| 4 | Anderson Hospital Maryville, IL professional · other · outpatient | 1 | $641 | $641 | — | — | — | $641 – $641 |
| 5 | Beaufort Memorial Hospital Beaufort, SC facility · case rate · outpatient | 1 | $5.1k | $5.1k | — | — | — | $5.1k – $5.1k |
| 6 | Bon Secours Community Hospital Jervis, NY facility · fee schedule · outpatient | 1 | $50k | $50k | — | — | — | $50k – $50k |
| 7 | Butler Healthcare Providers_ DBA Butler Memorial Hospital Butler, PA facility · case rate · outpatient | 1 | $5.0k | $5.0k | — | — | — | $5.0k – $5.0k |
| 8 | CLAIBORNE MEDICAL CENTER Tazewell, TN fee schedule · outpatient | 1 | $5.2k | $5.2k | — | — | — | $5.2k – $5.2k |
| 9 | CUMBERLAND MEDICAL CENTER, INC. Crossville, TN fee schedule · outpatient | 1 | $5.2k | $5.2k | — | — | — | $5.2k – $5.2k |
| 10 | Canton-Potsdam Hospital Potsdam, NY facility · fee schedule · outpatient | 1 | $506 | $506 | — | — | — | $506 – $506 |
| 11 | Cary Medical Center Caribou, ME case rate · outpatient | 1 | $5.0k | $5.0k | — | — | — | $5.0k – $5.0k |
| 12 | CentraState Medical Center Freehold Township, NJ other · outpatient | 2 | $2.6k | $2.6k | — | — | — | $2.6k – $2.6k |
| 13 | Chilton Medical Center Pompton Plains, NJ other · outpatient | 2 | $2.6k | $2.6k | — | — | — | $2.6k – $2.6k |
| 14 | Clarion Hospital Clarion, PA facility · case rate · outpatient | 1 | $5.0k | $5.0k | — | — | — | $5.0k – $5.0k |
| 15 | EAST BATON ROUGE MEDICAL CENTER, LLC Baton Rouge, LA other · outpatient | 1 | $4.7k | $4.7k | — | — | — | $4.7k – $4.7k |
| 16 | FORT LOUDOUN MEDICAL CENTER Lenoir City, TN fee schedule · outpatient | 1 | $4.8k | $4.8k | — | — | — | $4.8k – $4.8k |
| 17 | FORT SANDERS REGIONAL MEDICAL CENTER Knoxville, TN fee schedule · outpatient | 1 | $4.8k | $4.8k | — | — | — | $4.8k – $4.8k |
| 18 | Garden City Hospital City, MI fee schedule · outpatient | 1 | $5.3k | $5.3k | — | — | — | $5.3k – $5.3k |
| 19 | Gerald Champion Regional Medical Center Alamogordo, NM fee schedule · outpatient | 5 | $5.0k | $5.0k | — | — | — | $5.0k – $5.0k |
| 20 | Good Samaritan Hospital Suffern, NY facility · fee schedule · outpatient | 1 | $50k | $50k | — | — | — | $50k – $50k |
| 21 | HOSPITAL SERVICE DISTRICT NO. 1 OF THE PARISH OF ST. CHARLES, STATE OF LOUISIANA LULING, LA other · outpatient | 1 | $3.2k | $3.2k | $1.3k | 42% | — | $1.9k – $4.5k |
| 22 | HOSPITAL SERVICE DISTRICT OF THE PARISH OF ST. BERNARD, STATE OF LOUISIANA Chalmette, LA other · outpatient | 1 | $4.5k | $4.5k | — | — | — | $4.5k – $4.5k |
| 23 | HSA CGH LLC Coral Gables, FL facility · percent of total billed charges · outpatientfrom % of charges | 1 | $35k | $35k | — | — | — | $35k – $35k |
| 24 | HSA PGH LLC Hialeah, FL facility · percent of total billed charges · outpatientfrom % of charges | 1 | $35k | $35k | — | — | — | $35k – $35k |
| 25 | Hackettstown Medical Center Hackettstown, NJ other · outpatient | 2 | $2.6k | $2.6k | — | — | — | $2.6k – $2.6k |
← Payers reporting CPT 66991 · Snapshot 20261111T120946Z-9134e7f7