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
HB Bk Sleeve Susp/Sealing
Low
$139
Average
$222
Median
$156
High
$579
Each hospital's average Tricare rate, under the methodology and billing class chosen below.
33 hospitals; the 90th percentile is 3.0× 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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33 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 | Beaufort Memorial Hospital Beaufort, SC facility · fee schedule · outpatient | 1 | $155 | $155 | — | — | — | $155 – $155 |
| 2 | Butler Healthcare Providers_ DBA Butler Memorial Hospital Butler, PA facility · fee schedule · outpatient | 1 | $151 | $151 | — | — | — | $151 – $151 |
| 3 | Canton-Potsdam Hospital Potsdam, NY facility · fee schedule · outpatient | 1 | $139 | $139 | — | — | — | $139 – $139 |
| 4 | Clarion Hospital Clarion, PA facility · fee schedule · outpatient | 1 | $151 | $151 | — | — | — | $151 – $151 |
| 5 | Crestview Hospital Corporation Crestview, FL facility · fee schedule · outpatient | 1 | $151 | $151 | — | — | — | $151 – $151 |
| 6 | FORT LOUDOUN MEDICAL CENTER Lenoir City, TN fee schedule · outpatient | 1 | $159 | $159 | — | — | — | $159 – $159 |
| 7 | FORT SANDERS REGIONAL MEDICAL CENTER Knoxville, TN fee schedule · outpatient | 1 | $159 | $159 | — | — | — | $159 – $159 |
| 8 | IHC Health Services Inc., DBA Intermountain Primary Children's Hospital City, UT facility · fee schedule · outpatient | 1 | $156 | $156 | — | — | — | $156 – $156 |
| 9 | IHC Health Services Inc., DBA Intermountain Primary Children's Hospital Lehi, UT facility · fee schedule · outpatient | 1 | $156 | $156 | — | — | — | $156 – $156 |
| 10 | Jefferson Health - Northeast Langhorne, PA facility · fee schedule · outpatient | 1 | $154 | $154 | — | — | — | $154 – $154 |
| 11 | Jefferson Health - Northeast Philadelphia, PA facility · fee schedule · outpatient | 1 | $154 | $154 | — | — | — | $154 – $154 |
| 12 | Jefferson Health - Northeast Philadelphia, PA facility · fee schedule · outpatient | 1 | $154 | $154 | — | — | — | $154 – $154 |
| 13 | Kennedy University Hospital, Inc Turnersville, NJ facility · fee schedule · outpatient | 1 | $154 | $154 | — | — | — | $154 – $154 |
| 14 | Kennedy University Hospital, Inc Cherry Hill, NJ facility · fee schedule · outpatient | 1 | $154 | $154 | — | — | — | $154 – $154 |
| 15 | Kennedy University Hospital, Inc Stratford, NJ facility · fee schedule · outpatient | 1 | $154 | $154 | — | — | — | $154 – $154 |
| 16 | Lake Charles Memorial Hospital Charles., LA fee schedule · outpatient | 1 | $148 | $148 | — | — | — | $148 – $148 |
| 17 | Lansdale Hospital Corp Lansdale, PA facility · fee schedule · outpatient | 1 | $154 | $154 | — | — | — | $154 – $154 |
| 18 | Little Company of Mary Hospital of Indiana Inc Jasper, IN facility · case rate · outpatient | 1 | $157 | $157 | — | — | — | $157 – $157 |
| 19 | METHODIST MEDICAL CENTER OF OAK RIDGE Oak Ridge, TN fee schedule · outpatient | 1 | $159 | $159 | — | — | — | $159 – $159 |
| 20 | MORRISTOWN HAMBLEN HOSPITAL ASSOCIATION Morristown, TN fee schedule · outpatient | 1 | $159 | $159 | — | — | — | $159 – $159 |
| 21 | MedStar Franklin Square Medical Center Baltimore, MD percent of total billed charges · outpatientfrom % of charges | 1 | $470 | $470 | — | — | — | $470 – $470 |
| 22 | MedStar Georgetown Hospital Washington, DC facility · fee schedule · outpatient | 1 | $154 | $154 | — | — | — | $154 – $154 |
| 23 | MedStar Good Samaritan Hospital Baltimore, MD percent of total billed charges · outpatientfrom % of charges | 1 | $579 | $579 | — | — | — | $579 – $579 |
| 24 | MedStar Harbor Hospital Baltimore, MD percent of total billed charges · outpatientfrom % of charges | 1 | $385 | $385 | — | — | — | $385 – $385 |
| 25 | MedStar Montgomery Medical Center Olney, MD percent of total billed charges · outpatientfrom % of charges | 1 | $412 | $412 | — | — | — | $412 – $412 |
← Payers reporting HCPCS L5685 · Snapshot 20261111T120946Z-9134e7f7