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
Intake Evaluation Php
Low
$51
Average
$193
Median
$157
High
$2.9k
Each hospital's average Tricare rate, under the methodology and billing class chosen below.
228 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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268 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 | $163 | $163 | — | — | 45 | $163 – $163 |
| 2 | Catholic Health Initiatives-Iowa Corp Des Moines, IA professional · fee schedule · both | 1 | $105 | $105 | — | — | 21 | $105 – $105 |
| 3 | ROBERT PACKER HOSPITAL Sayre, PA facility · other · outpatient | 2 | $195 | $195 | $19 | 10% | 19 | $176 – $214 |
| 4 | Salem Hospital Salem, MA percent of total billed charges · bothfrom % of charges | 1 | $599 | $551 | $67 | 12% | 3–30 | $456 – $599 |
| 5 | Massachusetts General Hospital Boston, MA percent of total billed charges · bothfrom % of charges | 1 | $539 | $539 | $59 | 11% | 2–20 | $480 – $599 |
| 6 | MVHS, Inc. Utica, NY fee schedule · both | 1 | $156 | $149 | $10 | 7% | 1–10 | $134 – $156 |
| 7 | Mishawaka Medical Center Mishawaka, IN professional · fee schedule · both | 1 | $162 | $162 | — | — | 1–10 | $162 – $162 |
| 8 | Saint Alphonsus Regional Medical Center - Boise Boise, ID professional · fee schedule · both | 1 | $140 | $140 | — | — | 1–10 | $140 – $140 |
| 9 | Saint Francis Hospital and Medical Center Hartford, CT professional · fee schedule · outpatient | 1 | $142 | $142 | — | — | 1–10 | $142 – $142 |
| 10 | ACADIA GENERAL HOSPITAL, INC 1305 CROWLEY RAYNE HWY other · outpatient | 1 | $146 | $146 | — | — | — | $146 – $146 |
| 11 | ALBANY MEDICAL CENTER HOSPITAL Albany, NY professional · fee schedule · outpatient | 4 | $132 | $134 | $22 | 16% | — | $106 – $164 |
| 12 | AnMed Health Anderson, SC professional · fee schedule · inpatient | 1 | $145 | $145 | — | — | — | $145 – $145 |
| 13 | AnMed Health Anderson, SC professional · fee schedule · outpatient | 1 | $157 | $157 | $11 | 7% | — | $145 – $168 |
| 14 | AnMed Health Cannon Pickens, SC professional · fee schedule · inpatient | 1 | $145 | $145 | — | — | — | $145 – $145 |
| 15 | AnMed Health Cannon Pickens, SC professional · fee schedule · outpatient | 1 | $145 | $145 | — | — | — | $145 – $145 |
| 16 | AnMed Piedmont Piedmont, SC professional · fee schedule · inpatient | 1 | $145 | $145 | — | — | — | $145 – $145 |
| 17 | AnMed Piedmont Piedmont, SC professional · fee schedule · outpatient | 1 | $168 | $168 | — | — | — | $168 – $168 |
| 18 | Anderson Hospital Maryville, IL facility · fee schedule · outpatient | 1 | $5.7k | $5.7k | — | — | — | $5.7k – $5.7k |
| 19 | Anderson Hospital Maryville, IL professional · other · outpatient | 1 | $165 | $165 | — | — | — | $165 – $165 |
| 20 | Ascension Cedar Park Park, TX fee schedule · outpatient | 1 | $121 | $121 | — | — | — | $121 – $121 |
| 21 | Ascension Providence Waco, TX other · inpatient | 1 | $157 | $157 | — | — | — | $157 – $157 |
| 22 | Ascension Providence Waco, TX other · outpatient | 1 | $157 | $157 | — | — | — | $157 – $157 |
| 23 | Ascension Seton Austin, TX fee schedule · outpatient | 1 | $121 | $121 | — | — | — | $121 – $121 |
| 24 | Ascension Seton Austin, TX other · inpatient | 1 | $156 | $156 | — | — | — | $156 – $156 |
| 25 | Ascension Seton Austin, TX fee schedule · outpatient | 1 | $121 | $121 | — | — | — | $121 – $121 |
← Payers reporting CPT 90791 · Snapshot 20261111T120946Z-9134e7f7