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
PR VSRCTV STD TCD ICR ART COMPL
Low
$125
Average
$3.6k
Median
$958
High
$25.1k
Each hospital's average Tricare rate, under the methodology and billing class chosen below.
10 hospitals; the 90th percentile is 42.9× 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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12 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 | Anderson Hospital Maryville, IL facility · fee schedule · outpatient | 1 | $50k | $50k | — | — | — | $50k – $50k |
| 2 | Anderson Hospital Maryville, IL professional · other · outpatient | 1 | $161 | $161 | — | — | — | $161 – $161 |
| 3 | Canton-Potsdam Hospital Potsdam, NY facility · fee schedule · outpatient | 1 | $125 | $125 | — | — | — | $125 – $125 |
| 4 | Little Company of Mary Hospital of Indiana Inc Jasper, IN facility · case rate · outpatient | 1 | $137 | $137 | — | — | — | $137 – $137 |
| 5 | McLeod Health Cheraw, SC percent of total billed charges · bothfrom % of charges | 1 | $1.9k | $1.9k | — | — | — | $1.9k – $1.9k |
| 6 | MedStar Franklin Square Medical Center Baltimore, MD percent of total billed charges · outpatientfrom % of charges | 1 | $2.1k | $2.1k | — | — | — | $2.1k – $2.1k |
| 7 | Mid Hudson Regional Hospital Poughkeepsie, NY facility · fee schedule · outpatient | 1 | $958 | $958 | — | — | — | $958 – $958 |
| 8 | Newark-Wayne Community Hospital Newark, NY facility · fee schedule · outpatient | 1 | $139 | $139 | — | — | — | $139 – $139 |
| 9 | The Toledo Hospital Maumee, OH facility · fee schedule · outpatient | 1 | $1.4k | $1.4k | — | — | — | $1.4k – $1.4k |
| 10 | The Toledo Hospital Maumee, OH professional · fee schedule · outpatient | 1 | $152 | $152 | — | — | — | $152 – $152 |
| 11 | The Trustees of the University of Pennsylvania D/B/A The Hospital of the University of Pennsylvania Philadelphia, PA facility · fee schedule · outpatient | 1 | $3.7k | $3.7k | — | — | — | $3.7k – $3.7k |
| 12 | Westchester Medical Center Valhalla, NY facility · fee schedule · outpatient | 1 | $958 | $958 | — | — | — | $958 – $958 |
← Payers reporting CPT 93896 · Snapshot 20261112T181611Z-3fa9fb76