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
Tte w or w/o fol w/cont f/u
Low
$292
Average
$884
Median
$762
High
$5.7k
Each hospital's average Tricare rate, under the methodology and billing class chosen below.
58 hospitals; the 90th percentile is 2.1× 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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58 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 | Ascension Cedar Park Park, TX fee schedule · outpatient | 1 | $439 | $439 | — | — | — | $439 – $439 |
| 2 | Ascension Seton Bastrop, TX fee schedule · outpatient | 1 | $439 | $439 | — | — | — | $439 – $439 |
| 3 | Beaufort Memorial Hospital Beaufort, SC facility · fee schedule · outpatient | 1 | $778 | $778 | — | — | — | $778 – $778 |
| 4 | Butler Healthcare Providers_ DBA Butler Memorial Hospital Butler, PA facility · fee schedule · outpatient | 1 | $760 | $760 | — | — | — | $760 – $760 |
| 5 | CLAIBORNE MEDICAL CENTER Tazewell, TN fee schedule · outpatient | 1 | $762 | $762 | — | — | — | $762 – $762 |
| 6 | CORNING HOSPITAL Corning, NY facility · other · outpatient | 2 | $5.7k | $5.7k | — | — | — | $5.7k – $5.7k |
| 7 | CUMBERLAND MEDICAL CENTER, INC. Crossville, TN fee schedule · outpatient | 1 | $762 | $762 | — | — | — | $762 – $762 |
| 8 | Clarion Hospital Clarion, PA facility · fee schedule · outpatient | 1 | $760 | $760 | — | — | — | $760 – $760 |
| 9 | Dukes Health System LLC Peru, IN facility · fee schedule · outpatient | 1 | $325 | $325 | — | — | — | $325 – $325 |
| 10 | Dupont Hospital LLC Wayne, IN facility · fee schedule · outpatient | 1 | $788 | $788 | — | — | — | $788 – $788 |
| 11 | EAST BATON ROUGE MEDICAL CENTER, LLC Baton Rouge, LA other · outpatient | 1 | $726 | $726 | — | — | — | $726 – $726 |
| 12 | Eisenhower Medical Center Rancho Mirage, CA other · both | 3 | $1.0k | $1.0k | — | — | — | $1.0k – $1.0k |
| 13 | FORT LOUDOUN MEDICAL CENTER Lenoir City, TN fee schedule · outpatient | 1 | $711 | $711 | — | — | — | $711 – $711 |
| 14 | FORT SANDERS REGIONAL MEDICAL CENTER Knoxville, TN fee schedule · outpatient | 1 | $711 | $711 | — | — | — | $711 – $711 |
| 15 | GUTHRIE CORTLAND MEDICAL CENTER Cortland, NY facility · other · outpatient | 1 | $1.8k | $1.8k | — | — | — | $1.8k – $1.8k |
| 16 | Garden City Hospital City, MI fee schedule · outpatient | 1 | $778 | $778 | — | — | — | $778 – $778 |
| 17 | Gerald Champion Regional Medical Center Alamogordo, NM fee schedule · outpatient | 5 | $763 | $763 | — | — | — | $763 – $763 |
| 18 | IHC Health Services Inc., DBA Intermountain Primary Children's Hospital City, UT facility · fee schedule · outpatient | 1 | $757 | $757 | — | — | — | $757 – $757 |
| 19 | IHC Health Services Inc., DBA Intermountain Primary Children's Hospital Lehi, UT facility · fee schedule · outpatient | 1 | $757 | $757 | — | — | — | $757 – $757 |
| 20 | Kaleida Health Buffalo, NY fee schedule · outpatient | 1 | $930 | $930 | — | — | — | $930 – $930 |
| 21 | Knapp Medical Center Weslaco, TX fee schedule · outpatient | 1 | $784 | $784 | — | — | — | $784 – $784 |
| 22 | LECONTE MEDICAL CENTER Sevierville, TN fee schedule · outpatient | 1 | $762 | $762 | — | — | — | $762 – $762 |
| 23 | Little Company of Mary Hospital of Indiana Inc Jasper, IN facility · case rate · outpatient | 1 | $704 | $704 | — | — | — | $704 – $704 |
| 24 | Lower Bucks Hospital Bristol, PA fee schedule · outpatient | 1 | $771 | $771 | — | — | — | $771 – $771 |
| 25 | Lutheran Musculoskeletal Center LLC Fort Wayne, IN facility · fee schedule · outpatient | 1 | $788 | $788 | — | — | — | $788 – $788 |
← Payers reporting HCPCS C8922 · Snapshot 20261111T120946Z-9134e7f7