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
$251
Median
$217
High
$1.1k
Each hospital's average Tricare rate, under the methodology and billing class chosen below.
127 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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148 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 | ROBERT PACKER HOSPITAL Sayre, PA facility · other · outpatient | 2 | $290 | $290 | — | — | 53 | $290 – $290 |
| 2 | Mayo Clinic Health System Sparta, WI professional · fee schedule · outpatient | 1 | $225 | $225 | — | — | 2–20 | $225 – $225 |
| 3 | Brigham and Women's Hospital Boston, MA percent of total billed charges · bothfrom % of charges | 1 | $310 | $310 | — | — | 1–10 | $310 – $310 |
| 4 | Massachusetts General Hospital Boston, MA percent of total billed charges · bothfrom % of charges | 1 | $310 | $310 | — | — | 1–10 | $310 – $310 |
| 5 | Mayo Clinic Health System Cannon Falls 55009-5003 facility · percent of total billed charges · bothfrom % of charges | 1 | $118 | $118 | $0 | 0% | 1–10 | $118 – $118 |
| 6 | Mount Carmel St Ann's Lewis Center, OH professional · fee schedule · both | 1 | $228 | $228 | — | — | 1–10 | $228 – $228 |
| 7 | OUR LADY OF LOURDES MEMORIAL HOSPITAL INC. Doing Business As: LOURDES Binghamton, NY facility · other · outpatient | 1 | $210 | $210 | — | — | 1–10 | $210 – $210 |
| 8 | ALBANY MEDICAL CENTER HOSPITAL Albany, NY professional · fee schedule · outpatient | 4 | $228 | $228 | — | — | — | $228 – $228 |
| 9 | AnMed Health Anderson, SC professional · fee schedule · inpatient | 1 | $210 | $210 | — | — | — | $210 – $210 |
| 10 | AnMed Health Anderson, SC professional · fee schedule · outpatient | 1 | $210 | $210 | — | — | — | $210 – $210 |
| 11 | AnMed Health Cannon Pickens, SC professional · fee schedule · inpatient | 1 | $210 | $210 | — | — | — | $210 – $210 |
| 12 | AnMed Health Cannon Pickens, SC professional · fee schedule · outpatient | 1 | $210 | $210 | — | — | — | $210 – $210 |
| 13 | AnMed Piedmont Piedmont, SC professional · fee schedule · inpatient | 1 | $210 | $210 | — | — | — | $210 – $210 |
| 14 | AnMed Piedmont Piedmont, SC professional · fee schedule · outpatient | 1 | $210 | $210 | — | — | — | $210 – $210 |
| 15 | Anderson Hospital Maryville, IL facility · fee schedule · outpatient | 1 | $222 | $222 | — | — | — | $222 – $222 |
| 16 | Anderson Hospital Maryville, IL professional · other · outpatient | 1 | $226 | $226 | — | — | — | $226 – $226 |
| 17 | Armstrong County Memorial Hospital Kittanning, PA facility · fee schedule · outpatient | 1 | $228 | $228 | — | — | — | $228 – $228 |
| 18 | Aspen Valley Hospital District Aspen, CO facility · percent of total billed charges · bothfrom % of charges | 4 | $446 | $541 | $165 | 30% | — | $446 – $827 |
| 19 | Aspirus Ironwood Hospital Ironwood, MI fee schedule · both | 1 | $210 | $210 | — | — | — | $210 – $210 |
| 20 | Aspirus Rhinelander Hospital Rhinelander, WI fee schedule · both | 1 | $210 | $210 | — | — | — | $210 – $210 |
| 21 | Aspirus Wausau Hospital Wausau, WI fee schedule · both | 1 | $167 | $167 | — | — | — | $167 – $167 |
| 22 | Aspirus Wisconsin Rapids Hospital Wisconsin Rapids, WI fee schedule · both | 1 | $210 | $210 | — | — | — | $210 – $210 |
| 23 | Benefis Community Hospitals, Inc Choteau, MT other · both | 1 | $0 | $0 | — | — | — | $0 – $0 |
| 24 | Benefis Hospitals Inc Helena, MT fee schedule · outpatient | 1 | $210 | $210 | — | — | — | $210 – $210 |
| 25 | Bluffton Health System LLC Bluffton, IN facility · fee schedule · outpatient | 1 | $217 | $217 | — | — | — | $217 – $217 |
← Payers reporting CPT 90750 · Snapshot 20261111T120946Z-9134e7f7