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
facility
Low
$0
Average
$192
Median
$65
High
$12.5k
Each hospital's average Tricare rate, under the methodology and billing class chosen below.
164 hospitals; the 90th percentile is 7.3× 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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196 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 | Mayo Clinic Health System Sparta, WI professional · fee schedule · outpatient | 1 | $40 | $40 | — | — | 73–82 | $40 – $40 |
| 2 | MVHS, Inc. Utica, NY fee schedule · both | 1 | $39 | $39 | — | — | 50 | $39 – $39 |
| 3 | Catholic Health Initiatives-Iowa Corp Des Moines, IA professional · fee schedule · outpatient | 1 | $40 | $40 | — | — | 43 | $40 – $40 |
| 4 | Saint Alphonsus Regional Medical Center - Boise Boise, ID professional · fee schedule · outpatient | 1 | $40 | $40 | — | — | 23 | $40 – $40 |
| 5 | Columbia Lutheran Charities Astoria, OR facility · percent of total billed charges · bothfrom % of charges | 1 | $149 | $107 | $60 | 56% | 2–20 | $22 – $149 |
| 6 | Coulee Medical Center Grand Coulee, WA facility · percent of total billed charges · outpatientfrom % of charges | 1 | $153 | $153 | — | — | 1–10 | $153 – $153 |
| 7 | Fleming County Hospital Flemingsburg, KY facility · percent of total billed charges · outpatientfrom % of charges | 1 | $568 | $568 | — | — | 1–10 | $568 – $568 |
| 8 | Mayo Clinic Health System Cannon Falls 55009-5003 facility · percent of total billed charges · bothfrom % of charges | 1 | $34 | $34 | $0 | 1% | 1–10 | $34 – $35 |
| 9 | Mishawaka Medical Center Mishawaka, IN professional · fee schedule · both | 1 | $40 | $40 | — | — | 1–10 | $40 – $40 |
| 10 | Mount Carmel St Ann's Lewis Center, OH professional · fee schedule · both | 1 | $40 | $40 | — | — | 1–10 | $40 – $40 |
| 11 | Nazareth Hospital Philadelphia, PA professional · fee schedule · both | 1 | $38 | $38 | — | — | 1–10 | $38 – $38 |
| 12 | ROBERT PACKER HOSPITAL Sayre, PA facility · other · outpatient | 1 | $189 | $189 | $109 | 58% | 1–10 | $80 – $299 |
| 13 | Saint Francis Hospital and Medical Center Hartford, CT professional · fee schedule · both | 1 | $38 | $38 | — | — | 1–10 | $38 – $38 |
| 14 | Samaritan Hospital Troy, NY professional · fee schedule · outpatient | 1 | $38 | $38 | — | — | 1–10 | $38 – $38 |
| 15 | Springhill Memorial Hospital Mobile, AL other · outpatient | 1 | $7 | $7 | — | — | 1–10 | $7 – $7 |
| 16 | St Peters Hospital Albany, NY professional · fee schedule · outpatient | 1 | $38 | $38 | — | — | 1–10 | $38 – $38 |
| 17 | The Mercy Hospital Inc Springfield, MA professional · fee schedule · both | 1 | $38 | $38 | — | — | 1–10 | $38 – $38 |
| 18 | ALBANY MEDICAL CENTER HOSPITAL Albany, NY professional · fee schedule · outpatient | 4 | $39 | $39 | — | — | — | $39 – $39 |
| 19 | AnMed Health Anderson, SC professional · fee schedule · outpatient | 1 | $39 | $39 | — | — | — | $39 – $39 |
| 20 | AnMed Health Cannon Pickens, SC professional · fee schedule · outpatient | 1 | $39 | $39 | — | — | — | $39 – $39 |
| 21 | AnMed Piedmont Piedmont, SC professional · fee schedule · inpatient | 1 | $39 | $39 | — | — | — | $39 – $39 |
| 22 | AnMed Piedmont Piedmont, SC professional · fee schedule · outpatient | 1 | $39 | $39 | — | — | — | $39 – $39 |
| 23 | Anderson Hospital Maryville, IL facility · fee schedule · outpatient | 1 | $25.1k | $25.1k | $24.9k | 100% | — | $108 – $50k |
| 24 | Anderson Hospital Maryville, IL professional · other · outpatient | 1 | $39 | $39 | — | — | — | $39 – $39 |
| 25 | Armstrong County Memorial Hospital Kittanning, PA facility · fee schedule · outpatient | 1 | $241 | $241 | $2 | 1% | — | $239 – $243 |
← Payers reporting CPT 90715 · Snapshot 20261111T120946Z-9134e7f7