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
ARM ENDOSCOPE L32 CM 2 INCISION 2 RING APPLICATOR BAND OD8 MM FALOPE-RING
Low
$63
Average
$2.0k
Median
$2.0k
High
$5.6k
Each hospital's average Tricare rate, under the methodology and billing class chosen below.
24 hospitals; the 90th percentile is 3.5× 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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25 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 | Bluffton Health System LLC Bluffton, IN facility · fee schedule · outpatient | 1 | $2.0k | $2.0k | — | — | — | $2.0k – $2.0k |
| 2 | Brandon HMA LLC Brandon, MS facility · fee schedule · outpatient | 1 | $770 | $770 | — | — | — | $770 – $770 |
| 3 | Doylestown Hospital Doylestown, PA facility · fee schedule · outpatient | 1 | $2.1k | $2.1k | — | — | — | $2.1k – $2.1k |
| 4 | East Georgia Regional Medical Center LLC Statesboro, GA facility · fee schedule · outpatient | 1 | $2.0k | $2.0k | — | — | — | $2.0k – $2.0k |
| 5 | Ellis Hospital NY 12308; 2210 Troy Schenectady Road Niskayuna, NY facility · fee schedule · outpatient | 1 | $395 | $395 | — | — | — | $395 – $395 |
| 6 | HMA Santa Rosa Medical Center LLC Milton, FL facility · fee schedule · outpatient | 1 | $2.0k | $2.0k | — | — | — | $2.0k – $2.0k |
| 7 | Hospital Authority of Colquitt County Moultrie, GA fee schedule · both | 1 | $63 | $63 | $2 | 3% | — | $61 – $65 |
| 8 | Kaweah Health Medical Center Visalia, CA facility · fee schedule · outpatient | 1 | $2.1k | $2.1k | — | — | — | $2.1k – $2.1k |
| 9 | Kaweah Health Mental Health Hospital Visalia, CA facility · fee schedule · outpatient | 1 | $5.6k | $5.6k | $1.1k | 20% | — | $4.5k – $6.7k |
| 10 | Knox Hospital Company LLC Knox, IN facility · fee schedule · outpatient | 1 | $2.0k | $2.0k | — | — | — | $2.0k – $2.0k |
| 11 | Lancaster General Health Lancaster, PA facility · fee schedule · outpatient | 1 | $1.3k | $1.3k | $276 | 22% | — | $858 – $1.8k |
| 12 | Mat-Su Valley Medical Center LLC Palmer, AK facility · fee schedule · outpatient | 1 | $2.9k | $2.9k | — | — | — | $2.9k – $2.9k |
| 13 | Moberly Hospital Company LLC Moberly, MO facility · fee schedule · outpatient | 1 | $2.1k | $2.1k | — | — | — | $2.1k – $2.1k |
| 14 | NATIONWIDE CHILDREN'S HOSPITAL TOLEDO, LLC Toledo, OH facility · fee schedule · outpatient | 1 | $2.0k | $2.0k | — | — | — | $2.0k – $2.0k |
| 15 | Nationwide Children's Hospital Columbus, OH facility · fee schedule · outpatient | 1 | $2.0k | $2.0k | — | — | — | $2.0k – $2.0k |
| 16 | Pennsylvania Hospital of the University of Pennsylvania Health System Philadelphia, PA facility · fee schedule · outpatient | 1 | $1.8k | $1.8k | — | — | — | $1.8k – $1.8k |
| 17 | Poplar Bluff Regional Medical Center LLC Poplar Bluff, MO facility · fee schedule · outpatient | 1 | $2.1k | $2.1k | — | — | — | $2.1k – $2.1k |
| 18 | River Oaks Hospital LLC Flowood, MS facility · fee schedule · outpatient | 1 | $770 | $770 | — | — | — | $770 – $770 |
| 19 | Roswell Hospital Corporation Roswell, NM facility · fee schedule · outpatient | 1 | $2.1k | $2.1k | — | — | — | $2.1k – $2.1k |
| 20 | The Trustees of the University of Pennsylvania D/B/A The Hospital of the University of Pennsylvania Philadelphia, PA facility · fee schedule · outpatient | 1 | $1.8k | $1.8k | — | — | — | $1.8k – $1.8k |
| 21 | University Health Truman Medical Center Kansas City, MO facility · fee schedule · outpatient | 1 | $2.1k | $2.1k | — | — | — | $2.1k – $2.1k |
| 22 | VALLEY REGIONAL HOSPITAL CLAREMONT, NH percent of total billed charges · bothfrom % of charges | 1 | $881 | $881 | — | — | — | $881 – $881 |
| 23 | Victor Valley Global Medical Center Victorville, CA facility · fee schedule · outpatient | 1 | $2.0k | $2.0k | — | — | — | $2.0k – $2.0k |
| 24 | Victor Valley Global Medical Center Victorville, CA professional · fee schedule · outpatient | 1 | $6.6k | $6.6k | — | — | — | $6.6k – $6.6k |
| 25 | Warsaw Health System LLC Warsaw, IN facility · fee schedule · outpatient | 1 | $2.0k | $2.0k | — | — | — | $2.0k – $2.0k |
← Payers reporting HCPCS A4264 · Snapshot 20261111T120946Z-9134e7f7