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 Splnt Clvcl 48-54in 2xl
Low
$2
Average
$210
Median
$64
High
$8.3k
Each hospital's average Tricare rate, under the methodology and billing class chosen below.
115 hospitals; the 90th percentile is 19.0× 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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125 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 | Aspen Valley Hospital District Aspen, CO facility · percent of total billed charges · bothfrom % of charges | 4 | $31 | $43 | $17 | 41% | 4–40 | $29 – $94 |
| 2 | Springhill Memorial Hospital Mobile, AL other · outpatient | 1 | $5 | $5 | — | — | 1–10 | $5 – $5 |
| 3 | Ascension Seton Austin, TX fee schedule · outpatient | 1 | $57 | $57 | — | — | — | $57 – $57 |
| 4 | Ascension Seton Austin, TX fee schedule · outpatient | 1 | $57 | $57 | — | — | — | $57 – $57 |
| 5 | Ascension Seton Austin, TX fee schedule · outpatient | 1 | $57 | $57 | — | — | — | $57 – $57 |
| 6 | Ascension Seton Smithville, TX fee schedule · outpatient | 1 | $57 | $57 | — | — | — | $57 – $57 |
| 7 | Ascension Seton Bastrop, TX fee schedule · outpatient | 1 | $57 | $57 | — | — | — | $57 – $57 |
| 8 | Ascension Seton Austin, TX fee schedule · outpatient | 1 | $57 | $57 | — | — | — | $57 – $57 |
| 9 | Bay Park Community Hospital Oregon, OH facility · fee schedule · outpatient | 1 | $77 | $77 | — | — | — | $77 – $77 |
| 10 | Bay Park Community Hospital Oregon, OH professional · fee schedule · outpatient | 1 | $77 | $77 | — | — | — | $77 – $77 |
| 11 | Beaufort Memorial Hospital Beaufort, SC facility · fee schedule · outpatient | 1 | $66 | $66 | — | — | — | $66 – $66 |
| 12 | Brandon HMA LLC Brandon, MS facility · fee schedule · outpatient | 1 | $34 | $34 | — | — | — | $34 – $34 |
| 13 | Butler Healthcare Providers_ DBA Butler Memorial Hospital Butler, PA facility · fee schedule · outpatient | 1 | $75 | $75 | — | — | — | $75 – $75 |
| 14 | CORNING HOSPITAL Corning, NY facility · other · outpatient | 2 | $472 | $472 | — | — | — | $472 – $472 |
| 15 | Campbell County HMA, LLC LaFollette, TN facility · fee schedule · outpatient | 1 | $64 | $64 | — | — | — | $64 – $64 |
| 16 | Canton-Potsdam Hospital Potsdam, NY facility · fee schedule · outpatient | 1 | $69 | $69 | — | — | — | $69 – $69 |
| 17 | CentraState Medical Center Freehold Township, NJ other · outpatient | 2 | $8.3k | $8.3k | — | — | — | $8.3k – $8.3k |
| 18 | Central Maine Medical Center Lewiston, ME fee schedule · outpatient | 1 | $83 | $83 | — | — | — | $83 – $83 |
| 19 | Charleston Area Medical Center Charleston, WV percent of total billed charges · bothfrom % of charges | 1 | $26 | $103 | $109 | 106% | — | $26 – $257 |
| 20 | Chilton Medical Center Pompton Plains, NJ fee schedule · both | 2 | $74 | $74 | $2 | 2% | — | $72 – $75 |
| 21 | Chilton Medical Center Pompton Plains, NJ other · outpatient | 2 | $8.3k | $8.3k | — | — | — | $8.3k – $8.3k |
| 22 | Clarion Hospital Clarion, PA facility · fee schedule · outpatient | 1 | $75 | $75 | — | — | — | $75 – $75 |
| 23 | Cocke County HMA, LLC Newport, TN facility · fee schedule · outpatient | 1 | $64 | $64 | — | — | — | $64 – $64 |
| 24 | Dukes Health System LLC Peru, IN facility · fee schedule · outpatient | 1 | $28 | $28 | — | — | — | $28 – $28 |
| 25 | Durant HMA LLC Durant, OK facility · fee schedule · outpatient | 1 | $21 | $21 | — | — | — | $21 – $21 |
← Payers reporting HCPCS L3650 · Snapshot 20261111T120946Z-9134e7f7