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 Lo Rigid a/P Panel Prefab Custom Fit Pt T1
Low
$190
Average
$471
Median
$489
High
$778
Each hospital's average Tricare rate, under the methodology and billing class chosen below.
60 hospitals; the 90th percentile is 1.4× 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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62 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 | $483 | $483 | — | — | — | $483 – $483 |
| 2 | Beaufort Memorial Hospital Beaufort, SC facility · fee schedule · outpatient | 1 | $498 | $498 | — | — | — | $498 – $498 |
| 3 | Butler Healthcare Providers_ DBA Butler Memorial Hospital Butler, PA facility · fee schedule · outpatient | 1 | $483 | $483 | — | — | — | $483 – $483 |
| 4 | Campbell County HMA, LLC LaFollette, TN facility · fee schedule · outpatient | 1 | $483 | $483 | — | — | — | $483 – $483 |
| 5 | Canton-Potsdam Hospital Potsdam, NY facility · fee schedule · outpatient | 1 | $444 | $444 | — | — | — | $444 – $444 |
| 6 | Central Maine Medical Center Lewiston, ME fee schedule · outpatient | 1 | $493 | $493 | — | — | — | $493 – $493 |
| 7 | Clarion Hospital Clarion, PA facility · fee schedule · outpatient | 1 | $483 | $483 | — | — | — | $483 – $483 |
| 8 | Cocke County HMA, LLC Newport, TN facility · fee schedule · outpatient | 1 | $483 | $483 | — | — | — | $483 – $483 |
| 9 | FORT LOUDOUN MEDICAL CENTER Lenoir City, TN fee schedule · outpatient | 1 | $508 | $508 | — | — | — | $508 – $508 |
| 10 | FORT SANDERS REGIONAL MEDICAL CENTER Knoxville, TN fee schedule · outpatient | 1 | $508 | $508 | — | — | — | $508 – $508 |
| 11 | Garfield County, a political subdivision of the State of Utah, DBA Intermountain Health Garfield Memorial Hospital Panguitch, UT facility · percent of total billed charges · inpatientfrom % of charges | 1 | $240 | $240 | — | — | — | $240 – $240 |
| 12 | Garfield County, a political subdivision of the State of Utah, DBA Intermountain Health Garfield Memorial Hospital Panguitch, UT facility · percent of total billed charges · outpatientfrom % of charges | 1 | $202 | $202 | — | — | — | $202 – $202 |
| 13 | HMA Santa Rosa Medical Center LLC Milton, FL facility · fee schedule · outpatient | 1 | $394 | $394 | — | — | — | $394 – $394 |
| 14 | Holy Cross Germantown Hospital Germantown, MD facility · percent of total billed charges · bothfrom % of charges | 1 | $778 | $778 | $523 | 67% | — | $255 – $1.3k |
| 15 | Holy Cross Hospital-Silver Spring Silver Spring, MD facility · percent of total billed charges · bothfrom % of charges | 1 | $635 | $635 | $449 | 71% | — | $187 – $1.1k |
| 16 | Hospital Authority of Colquitt County Moultrie, GA fee schedule · both | 1 | $357 | $357 | — | — | — | $357 – $357 |
| 17 | Hospital Service District #1, Parish of Terrebonne, State of Louisiana dba Terrebonne General Health System Houma, LA facility · fee schedule · outpatient | 1 | $508 | $508 | — | — | — | $508 – $508 |
| 18 | IHC Health Services Inc., DBA Intermountain Primary Children's Hospital City, UT facility · fee schedule · outpatient | 1 | $502 | $502 | — | — | — | $502 – $502 |
| 19 | IHC Health Services Inc., DBA Intermountain Primary Children's Hospital Lehi, UT facility · fee schedule · outpatient | 1 | $502 | $502 | — | — | — | $502 – $502 |
| 20 | Jefferson County HMA LLC Jefferson City, TN facility · fee schedule · outpatient | 1 | $483 | $483 | — | — | — | $483 – $483 |
| 21 | Lake Charles Memorial Hospital Charles., LA fee schedule · outpatient | 1 | $474 | $474 | — | — | — | $474 – $474 |
| 22 | Little Company of Mary Hospital of Indiana Inc Jasper, IN facility · case rate · outpatient | 1 | $502 | $502 | — | — | — | $502 – $502 |
| 23 | MCLAREN BAY REGION CITY, MI fee schedule | 1 | $485 | $485 | — | — | — | $485 – $485 |
| 24 | MCLAREN CARO REGION CARO, MI fee schedule | 1 | $276 | $276 | — | — | — | $276 – $276 |
| 25 | MCLAREN CENTRAL MICHIGAN PLEASANT, MI fee schedule | 1 | $437 | $437 | — | — | — | $437 – $437 |
← Payers reporting HCPCS L0627 · Snapshot 20261111T120946Z-9134e7f7