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
HC TBS TECHNICAL CALCULATION ONLY
Low
$23
Average
$113
Median
$85
High
$2.3k
Each hospital's average Tricare rate, under the methodology and billing class chosen below.
72 hospitals; the 90th percentile is 1.8× 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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83 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 | Brigham and Women's Hospital Boston, MA other · both | 1 | $99 | $99 | — | — | 1–10 | $99 – $99 |
| 2 | Mayo Clinic Health System Cannon Falls 55009-5003 facility · percent of total billed charges · bothfrom % of charges | 1 | $135 | $135 | — | — | 1–10 | $135 – $135 |
| 3 | ACADIA GENERAL HOSPITAL, INC 1305 CROWLEY RAYNE HWY other · outpatient | 1 | $80 | $80 | — | — | — | $80 – $80 |
| 4 | Anderson Hospital Maryville, IL facility · fee schedule · outpatient | 1 | $4.6k | $4.6k | — | — | — | $4.6k – $4.6k |
| 5 | Anderson Hospital Maryville, IL professional · other · outpatient | 1 | $24 | $24 | — | — | — | $24 – $24 |
| 6 | Ascension Providence Waco, TX other · inpatient | 1 | $86 | $86 | — | — | — | $86 – $86 |
| 7 | Ascension Providence Waco, TX other · outpatient | 1 | $86 | $86 | — | — | — | $86 – $86 |
| 8 | Ascension Seton Austin, TX other · inpatient | 1 | $85 | $85 | — | — | — | $85 – $85 |
| 9 | Ascension Seton Austin, TX other · inpatient | 1 | $85 | $85 | — | — | — | $85 – $85 |
| 10 | Ascension Seton Bastrop, TX other · inpatient | 1 | $85 | $85 | — | — | — | $85 – $85 |
| 11 | Ascension Seton Austin, TX other · inpatient | 1 | $85 | $85 | — | — | — | $85 – $85 |
| 12 | Beaufort Memorial Hospital Beaufort, SC facility · fee schedule · outpatient | 1 | $87 | $87 | — | — | — | $87 – $87 |
| 13 | Butler Healthcare Providers_ DBA Butler Memorial Hospital Butler, PA facility · fee schedule · outpatient | 1 | $85 | $85 | — | — | — | $85 – $85 |
| 14 | CLAIBORNE MEDICAL CENTER Tazewell, TN fee schedule · outpatient | 1 | $85 | $85 | — | — | — | $85 – $85 |
| 15 | CUMBERLAND MEDICAL CENTER, INC. Crossville, TN fee schedule · outpatient | 1 | $85 | $85 | — | — | — | $85 – $85 |
| 16 | Canton-Potsdam Hospital Potsdam, NY facility · fee schedule · outpatient | 1 | $23 | $23 | — | — | — | $23 – $23 |
| 17 | CentraState Medical Center Freehold Township, NJ other · outpatient | 2 | $102 | $102 | — | — | — | $102 – $102 |
| 18 | Chilton Medical Center Pompton Plains, NJ other · outpatient | 2 | $102 | $102 | — | — | — | $102 – $102 |
| 19 | Clarion Hospital Clarion, PA facility · fee schedule · outpatient | 1 | $85 | $85 | — | — | — | $85 – $85 |
| 20 | EAST BATON ROUGE MEDICAL CENTER, LLC Baton Rouge, LA other · outpatient | 1 | $81 | $81 | — | — | — | $81 – $81 |
| 21 | FORT LOUDOUN MEDICAL CENTER Lenoir City, TN fee schedule · outpatient | 1 | $79 | $79 | — | — | — | $79 – $79 |
| 22 | FORT SANDERS REGIONAL MEDICAL CENTER Knoxville, TN fee schedule · outpatient | 1 | $79 | $79 | — | — | — | $79 – $79 |
| 23 | Garfield County, a political subdivision of the State of Utah, DBA Intermountain Health Garfield Memorial Hospital Panguitch, UT facility · percent of total billed charges · inpatientfrom % of charges | 1 | $116 | $116 | — | — | — | $116 – $116 |
| 24 | Garfield County, a political subdivision of the State of Utah, DBA Intermountain Health Garfield Memorial Hospital Panguitch, UT facility · percent of total billed charges · outpatientfrom % of charges | 1 | $97 | $97 | — | — | — | $97 – $97 |
| 25 | Gerald Champion Regional Medical Center Alamogordo, NM fee schedule · outpatient | 5 | $87 | $87 | — | — | — | $87 – $87 |
← Payers reporting CPT 77091 · Snapshot 20261111T120946Z-9134e7f7