HC Tlso Triplanar Control Rigid Two Plastic Shells W/ Interface Liner Cust Prefab Rest Non-Mm Supply

Reported by 87 hospitals in the network under the percent of billed charges methodology.

Filter by billing methodology

Reflects a negotiated percentage of total billed charges.

National pricing summary

Low

$1.3k

Average

$4.9k

Median

$4.9k

High

$9.8k

#	Hospital	Location
1	Saint Alphonsus Regional Medical Center - Boise	Boise, ID	$1.5k	$1.3k	$377	—	$498	$2.7k
2	IHC Health Services Inc., DBA Intermountain Health Intermountain Medical Center	Murray, UT	$5.5k	$4.9k	$1.4k	—	$91	$6.8k
3	IHC Health Services Inc., DBA Intermountain Health Utah Valley Hospital	Provo, UT	$5.5k	$5.0k	$1.4k	—	$106	$6.8k
4	IHC Health Services Inc., DBA Intermountain Health McKay-Dee Hospital	Ogden, UT	$5.5k	$5.0k	$1.4k	—	$76	$7.6k
5	IHC Health Services Inc., DBA Intermountain Health St George Regional Hospital	St. George, UT	$5.1k	$4.9k	$903	—	$115	$5.4k
6	IHC Health Services Inc., DBA Intermountain Health LDS Hospital	Salt Lake City, UT	$5.5k	$5.0k	$1.4k	—	$99	$6.8k
7	Scl Health - Montana, Dba Intermountain Health St. Vincent Healthcare	Billings, MT	$6.3k	$6.2k	$973	—	$4.2k	$7.3k
8	Saint Joseph Hospital, Inc. Dba Intermountain Nhealth Saint Joseph Hospital	DENVER, CO	$9.8k	$9.7k	$4.1k	—	$3.2k	$17.1k
9	IHC Health Services Inc., DBA Intermountain Health Logan Regional Hospital	Logan, UT	$5.1k	$4.8k	$1.1k	—	$127	$5.8k
10	St. Mary's Hospital & Medical Center, Inc. Dba Intermountain Health St. Mary's Regional Hospital	JUNCTION, CO	$6.6k	$5.9k	$1.4k	—	$2.8k	$7.7k

Page 1 of 9

Ask Claude or any MCP client for CPT L0486 pricing at a specific hospital — see how to connect.

Reported by 87 hospitals in the network under the percent of billed charges methodology.

Filter by billing methodology

Reflects a negotiated percentage of total billed charges.

Low

$1.3k

Average

$4.9k

Median

$4.9k

High

$9.8k

#	Hospital	Location
1	Saint Alphonsus Regional Medical Center - Boise	Boise, ID	$1.5k	$1.3k	$377	—	$498	$2.7k
2	IHC Health Services Inc., DBA Intermountain Health Intermountain Medical Center	Murray, UT	$5.5k	$4.9k	$1.4k	—	$91	$6.8k
3	IHC Health Services Inc., DBA Intermountain Health Utah Valley Hospital	Provo, UT	$5.5k	$5.0k	$1.4k	—	$106	$6.8k
4	IHC Health Services Inc., DBA Intermountain Health McKay-Dee Hospital	Ogden, UT	$5.5k	$5.0k	$1.4k	—	$76	$7.6k
5	IHC Health Services Inc., DBA Intermountain Health St George Regional Hospital	St. George, UT	$5.1k	$4.9k	$903	—	$115	$5.4k
6	IHC Health Services Inc., DBA Intermountain Health LDS Hospital	Salt Lake City, UT	$5.5k	$5.0k	$1.4k	—	$99	$6.8k
7	Scl Health - Montana, Dba Intermountain Health St. Vincent Healthcare	Billings, MT	$6.3k	$6.2k	$973	—	$4.2k	$7.3k
8	Saint Joseph Hospital, Inc. Dba Intermountain Nhealth Saint Joseph Hospital	DENVER, CO	$9.8k	$9.7k	$4.1k	—	$3.2k	$17.1k
9	IHC Health Services Inc., DBA Intermountain Health Logan Regional Hospital	Logan, UT	$5.1k	$4.8k	$1.1k	—	$127	$5.8k
10	St. Mary's Hospital & Medical Center, Inc. Dba Intermountain Health St. Mary's Regional Hospital	JUNCTION, CO	$6.6k	$5.9k	$1.4k	—	$2.8k	$7.7k

Page 1 of 9

Ask Claude or any MCP client for CPT L0486 pricing at a specific hospital — see how to connect.