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
Limited US Pelvic (Non-OB)
Low
$21
Average
$120
Median
$104
High
$1.2k
Each hospital's average Tricare rate, under the methodology and billing class chosen below.
367 hospitals; the 90th percentile is 2.5× 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
422 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 | STATE OF MISSISSIPPI-UNIVERSITY OF MISSISSIPPI MEDICAL CENTER JACKSON, MS other · outpatient | 1 | $94 | $94 | — | — | 13 | $94 – $94 |
| 2 | Columbia Lutheran Charities Astoria, OR facility · percent of total billed charges · bothfrom % of charges | 1 | $74 | $66 | $16 | 24% | 4–40 | $39 – $77 |
| 3 | Mississippi Baptist Medical Center Jackson, MS facility · other · outpatient | 1 | $94 | $94 | — | — | 4–40 | $94 – $94 |
| 4 | Benefis Hospitals Inc Helena, MT other · outpatient | 1 | $106 | $106 | — | — | 2–20 | $106 – $106 |
| 5 | Brigham and Women's Hospital Boston, MA other · both | 1 | $120 | $120 | — | — | 2–20 | $120 – $120 |
| 6 | CORNING HOSPITAL Corning, NY facility · other · outpatient | 2 | $126 | $126 | — | — | 2–20 | $126 – $126 |
| 7 | GUTHRIE CORTLAND MEDICAL CENTER Cortland, NY facility · other · outpatient | 1 | $135 | $135 | — | — | 2–20 | $135 – $135 |
| 8 | ROBERT PACKER HOSPITAL Sayre, PA facility · other · outpatient | 2 | $150 | $483 | $596 | 123% | 2–20 | $117 – $1.5k |
| 9 | Mercy Hospital Berryville Berryville, AR facility · percent of total billed charges · outpatientfrom % of charges | 1 | $168 | $168 | — | — | 1–10 | $168 – $168 |
| 10 | Mercy Hospital Lebanon dba Mercy Hospital Lebanon Rolla, MO facility · other · outpatient | 1 | $110 | $110 | — | — | 1–10 | $110 – $110 |
| 11 | Mercy Hospital Rogers dba Mercy Hospital Northwest Arkansas Rogers, AR facility · other · outpatient | 1 | $96 | $96 | — | — | 1–10 | $96 – $96 |
| 12 | Mercy Hospital Springfield Ozark, MO facility · other · outpatient | 1 | $103 | $103 | — | — | 1–10 | $103 – $103 |
| 13 | Mercy Hospital Springfield Springfield, MO facility · other · outpatient | 1 | $103 | $103 | — | — | 1–10 | $103 – $103 |
| 14 | NEMOURS CHILDREN'S HOSPITAL STE 100 LAKE MARY, FL other · outpatient | 1 | $107 | $107 | — | — | 1–10 | $107 – $107 |
| 15 | NEMOURS CHILDREN'S HOSPITAL Philadelphia, PA case rate · outpatient | 1 | $111 | $111 | — | — | 1–10 | $111 – $111 |
| 16 | PRISMA HEALTH BAPTIST COLUMBIA HOSPITAL COLUMBIA, SC other · both | 1 | $98 | $98 | — | — | 1–10 | $98 – $98 |
| 17 | PRISMA HEALTH BAPTIST PARKRIDGE HOSPITAL COLUMBIA, SC other · both | 1 | $100 | $100 | — | — | 1–10 | $100 – $100 |
| 18 | PRISMA HEALTH BLOUNT MEMORIAL HOSPITAL MARYVILLE, TN other · both | 1 | $99 | $99 | — | — | 1–10 | $99 – $99 |
| 19 | PRISMA HEALTH GREER MEMORIAL HOSPITAL GREER, SC other · both | 1 | $99 | $99 | — | — | 1–10 | $99 – $99 |
| 20 | PRISMA HEALTH RICHLAND HOSPITAL COLUMBIA, SC other · both | 1 | $100 | $100 | — | — | 1–10 | $100 – $100 |
| 21 | PRISMA HEALTH TUOMEY HOSPITAL SUMTER, SC other · both | 1 | $100 | $100 | — | — | 1–10 | $100 – $100 |
| 22 | Springhill Memorial Hospital Mobile, AL other · outpatient | 1 | $96 | $96 | — | — | 1–10 | $96 – $96 |
| 23 | ACADIA GENERAL HOSPITAL, INC 1305 CROWLEY RAYNE HWY other · outpatient | 1 | $97 | $97 | — | — | — | $97 – $97 |
| 24 | ALBANY MEDICAL CENTER HOSPITAL Albany, NY professional · fee schedule · outpatient | 4 | $22 | $29 | $12 | 41% | — | $19 – $47 |
| 25 | Affinity Hospital LLC Birmingham, AL facility · fee schedule · outpatient | 1 | $91 | $91 | — | — | — | $91 – $91 |
← Payers reporting CPT 76857 · Snapshot 20261111T120946Z-9134e7f7