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 ANRCT MANO RCT SNSATN & BALO
Low
$175
Average
$674
Median
$398
High
$5.7k
Each hospital's average Tricare rate, under the methodology and billing class chosen below.
21 hospitals; the 90th percentile is 2.7× 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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24 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 | Affinity Hospital LLC Birmingham, AL facility · fee schedule · outpatient | 1 | $324 | $324 | — | — | — | $324 – $324 |
| 2 | Anderson Hospital Maryville, IL facility · fee schedule · outpatient | 1 | $5.7k | $5.7k | — | — | — | $5.7k – $5.7k |
| 3 | Canton-Potsdam Hospital Potsdam, NY facility · fee schedule · outpatient | 1 | $175 | $175 | — | — | — | $175 – $175 |
| 4 | Catholic Health Initiatives-Iowa Corp Des Moines, IA professional · percent of total billed charges · inpatientfrom % of charges | 1 | $309 | $309 | — | — | — | $309 – $309 |
| 5 | Catholic Health Initiatives-Iowa Corp Des Moines, IA professional · percent of total billed charges · outpatientfrom % of charges | 1 | $247 | $247 | — | — | — | $247 – $247 |
| 6 | Kaweah Health Medical Center Visalia, CA facility · fee schedule · outpatient | 1 | $480 | $480 | — | — | — | $480 – $480 |
| 7 | Kaweah Health Mental Health Hospital Visalia, CA facility · fee schedule · outpatient | 1 | $748 | $748 | — | — | — | $748 – $748 |
| 8 | MedStar Washington Hospital Center NW, WA facility · fee schedule · outpatient | 1 | $441 | $441 | — | — | — | $441 – $441 |
| 9 | Mercy Hospital Oklahoma City Inc City, OK facility · other · outpatient | 1 | $345 | $345 | — | — | — | $345 – $345 |
| 10 | Mid Hudson Regional Hospital Poughkeepsie, NY facility · fee schedule · outpatient | 1 | $466 | $466 | — | — | — | $466 – $466 |
| 11 | NATIONWIDE CHILDREN'S HOSPITAL TOLEDO, LLC Toledo, OH facility · fee schedule · outpatient | 1 | $362 | $362 | — | — | — | $362 – $362 |
| 12 | National Rehabilitation Hospital Washington, WA facility · fee schedule · outpatient | 1 | $397 | $397 | — | — | — | $397 – $397 |
| 13 | Nationwide Children's Hospital Columbus, OH facility · fee schedule · outpatient | 1 | $362 | $362 | — | — | — | $362 – $362 |
| 14 | Nationwide Children's Hospital Columbus, OH professional · percent of total billed charges · outpatientfrom % of charges | 1 | $293 | $293 | — | — | — | $293 – $293 |
| 15 | Newark-Wayne Community Hospital Newark, NY facility · fee schedule · outpatient | 1 | $195 | $195 | — | — | — | $195 – $195 |
| 16 | Northwest Hospital LLC Tucson, AZ facility · fee schedule · outpatient | 1 | $398 | $398 | — | — | — | $398 – $398 |
| 17 | Northwest Sahurita Hospital LLC Tucson, AZ facility · fee schedule · outpatient | 1 | $398 | $398 | — | — | — | $398 – $398 |
| 18 | Northwest Sahurita Hospital LLC Sahuarita, AZ facility · fee schedule · outpatient | 1 | $398 | $398 | — | — | — | $398 – $398 |
| 19 | Oro Valley Hospital LLC Tucson, AZ facility · fee schedule · outpatient | 1 | $398 | $398 | — | — | — | $398 – $398 |
| 20 | PRISMA HEALTH NORTH GREENVILLE LTACH HOSPITAL TRAVELERS REST, SC percent of total billed charges · bothfrom % of charges | 1 | $762 | $762 | — | — | — | $762 – $762 |
| 21 | University Health Truman Medical Center Kansas City, MO facility · fee schedule · outpatient | 1 | $374 | $374 | — | — | — | $374 – $374 |
| 22 | University of Texas MD Anderson Cancer Center The University of Texas M D Anderson Cancer Center Houston, TX facility · percent of total billed charges · bothfrom % of charges | 1 | $1.8k | $1.8k | — | — | — | $1.8k – $1.8k |
| 23 | University of Texas MD Anderson Cancer Center The University of Texas M D Anderson Cancer Center Houston, TX professional · fee schedule · both | 2 | $134 | $134 | $11 | 8% | — | $123 – $145 |
| 24 | Westchester Medical Center Valhalla, NY facility · fee schedule · outpatient | 1 | $466 | $466 | — | — | — | $466 – $466 |
← Payers reporting CPT 91125 · Snapshot 20261112T181611Z-3fa9fb76