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
Pavlik Harness
Low
$103
Average
$208
Median
$166
High
$1.1k
Each hospital's average Tricare rate, under the methodology and billing class chosen below.
20 hospitals; the 90th percentile is 1.3× 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.
Filter by billing methodology
Filter by billing class
21 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 | Massachusetts General Hospital Boston, MA percent of total billed charges · bothfrom % of charges | 1 | $194 | $194 | — | — | 1–10 | $194 – $194 |
| 2 | Beaufort Memorial Hospital Beaufort, SC facility · fee schedule · outpatient | 1 | $163 | $163 | — | — | — | $163 – $163 |
| 3 | Butler Healthcare Providers_ DBA Butler Memorial Hospital Butler, PA facility · fee schedule · outpatient | 1 | $181 | $181 | — | — | — | $181 – $181 |
| 4 | Canton-Potsdam Hospital Potsdam, NY facility · fee schedule · outpatient | 1 | $153 | $153 | — | — | — | $153 – $153 |
| 5 | Charleston Area Medical Center Charleston, WV percent of total billed charges · bothfrom % of charges | 1 | $1.1k | $1.1k | — | — | — | $1.1k – $1.1k |
| 6 | Clarion Hospital Clarion, PA facility · fee schedule · outpatient | 1 | $181 | $181 | — | — | — | $181 – $181 |
| 7 | FORT LOUDOUN MEDICAL CENTER Lenoir City, TN fee schedule · outpatient | 1 | $166 | $166 | — | — | — | $166 – $166 |
| 8 | FORT SANDERS REGIONAL MEDICAL CENTER Knoxville, TN fee schedule · outpatient | 1 | $166 | $166 | — | — | — | $166 – $166 |
| 9 | 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 | $112 | $112 | — | — | — | $112 – $112 |
| 10 | 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 | $94 | $94 | — | — | — | $94 – $94 |
| 11 | IHC Health Services Inc., DBA Intermountain Primary Children's Hospital City, UT facility · fee schedule · outpatient | 1 | $151 | $151 | — | — | — | $151 – $151 |
| 12 | IHC Health Services Inc., DBA Intermountain Primary Children's Hospital Lehi, UT facility · fee schedule · outpatient | 1 | $151 | $151 | — | — | — | $151 – $151 |
| 13 | Little Company of Mary Hospital of Indiana Inc Jasper, IN facility · case rate · outpatient | 1 | $171 | $171 | — | — | — | $171 – $171 |
| 14 | METHODIST MEDICAL CENTER OF OAK RIDGE Oak Ridge, TN fee schedule · outpatient | 1 | $166 | $166 | — | — | — | $166 – $166 |
| 15 | MORRISTOWN HAMBLEN HOSPITAL ASSOCIATION Morristown, TN fee schedule · outpatient | 1 | $166 | $166 | — | — | — | $166 – $166 |
| 16 | Nationwide Children's Hospital Columbus, OH professional · percent of total billed charges · outpatientfrom % of charges | 1 | $107 | $107 | — | — | — | $107 – $107 |
| 17 | OCHSNER CLINIC FOUNDATION LA 70121; 4430 Veterans Memorial Blvd.Metairie, LA fee schedule · outpatient | 1 | $143 | $143 | $8 | 5% | — | $136 – $151 |
| 18 | PARKWEST MEDICAL CENTER Knoxville, TN fee schedule · outpatient | 1 | $166 | $166 | — | — | — | $166 – $166 |
| 19 | PARKWEST MEDICAL CENTER Louisville, TN fee schedule · outpatient | 1 | $166 | $166 | — | — | — | $166 – $166 |
| 20 | Parrish Medical Center TITUSVILLE, FL facility · fee schedule · outpatient | 1 | $166 | $166 | — | — | — | $166 – $166 |
| 21 | ROANE COUNTY MEDICAL CENTER Harriman, TN fee schedule · outpatient | 1 | $166 | $166 | — | — | — | $166 – $166 |
← Payers reporting HCPCS L1620 · Snapshot 20261111T120946Z-9134e7f7