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
Sewho cap design w/jnt(s) cf
The 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.
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16 hospital rates
| # | Plans | |||
|---|---|---|---|---|
| 1 | Beaufort Memorial Hospital Beaufort, SC facility · fee schedule · outpatient | 1 | $2,076 | $2,076 – $2,076 |
| 2 | Butler Healthcare Providers_ DBA Butler Memorial Hospital Butler, PA facility · fee schedule · outpatient | 1 | $2,015 | $2,015 – $2,015 |
| 3 | Canton-Potsdam Hospital Potsdam, NY facility · fee schedule · outpatient | 1 | $1,850 | $1,850 – $1,850 |
| 4 | Clarion Hospital Clarion, PA facility · fee schedule · outpatient | 1 | $2,015 | $2,015 – $2,015 |
| 5 | FORT LOUDOUN MEDICAL CENTER Lenoir City, TN fee schedule · outpatient | 1 | $2,117 | $2,117 – $2,117 |
| 6 | FORT SANDERS REGIONAL MEDICAL CENTER Knoxville, TN fee schedule · outpatient | 1 | $2,117 | $2,117 – $2,117 |
| 7 | IHC Health Services Inc., DBA Intermountain Primary Children's Hospital City, UT facility · fee schedule · outpatient | 1 | $2,087 | $2,087 – $2,087 |
| 8 | IHC Health Services Inc., DBA Intermountain Primary Children's Hospital Lehi, UT facility · fee schedule · outpatient | 1 | $2,087 | $2,087 – $2,087 |
| 9 | Kaweah Health Medical Center Visalia, CA facility · fee schedule · outpatient | 1 | $2,056 | $2,056 – $2,056 |
| 10 | Kaweah Health Mental Health Hospital Visalia, CA facility · fee schedule · outpatient | 1 | $2,617 | $2,617 – $2,617 |
| 11 | Little Company of Mary Hospital of Indiana Inc Jasper, IN facility · case rate · outpatient | 1 | $2,090 | $2,090 – $2,090 |
| 12 | METHODIST MEDICAL CENTER OF OAK RIDGE Oak Ridge, TN fee schedule · outpatient | 1 | $2,117 | $2,117 – $2,117 |
| 13 | MORRISTOWN HAMBLEN HOSPITAL ASSOCIATION Morristown, TN fee schedule · outpatient | 1 | $2,117 | $2,117 – $2,117 |
| 14 | PARKWEST MEDICAL CENTER Knoxville, TN fee schedule · outpatient | 1 | $2,117 | $2,117 – $2,117 |
| 15 | PARKWEST MEDICAL CENTER Louisville, TN fee schedule · outpatient | 1 | $2,117 | $2,117 – $2,117 |
| 16 | ROANE COUNTY MEDICAL CENTER Harriman, TN fee schedule · outpatient | 1 | $2,117 | $2,117 – $2,117 |
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