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
Earmold Standard
Low
$33
Average
$56
Median
$60
High
$68
Each hospital's average Tricare rate, under the methodology and billing class chosen below.
10 hospitals; the 90th percentile is 1.7× 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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12 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 | Charleston Area Medical Center Charleston, WV percent of total billed charges · bothfrom % of charges | 1 | $59 | $56 | $29 | 52% | — | $20 – $127 |
| 2 | Dukes Health System LLC Peru, IN facility · fee schedule · outpatient | 1 | $55 | $39 | $24 | 61% | — | $10 – $65 |
| 3 | Fisher-Titus Medical Center Norwalk, OH professional · percent of total billed charges · inpatientfrom % of charges | 1 | $57 | $57 | $21 | 37% | — | $36 – $78 |
| 4 | Fisher-Titus Medical Center Norwalk, OH professional · percent of total billed charges · outpatientfrom % of charges | 1 | $53 | $53 | $20 | 37% | — | $34 – $73 |
| 5 | Hospital Authority of Colquitt County Moultrie, GA fee schedule · both | 1 | $67 | $67 | — | — | — | $67 – $67 |
| 6 | Mayo Clinic Health System Sparta, WI professional · percent of total billed charges · outpatientfrom % of charges | 1 | $25 | $33 | $12 | 35% | — | $25 – $50 |
| 7 | Mayo Clinic Health System Cannon Falls 55009-5003 facility · percent of total billed charges · bothfrom % of charges | 1 | $43 | $43 | — | — | — | $43 – $43 |
| 8 | NATIONWIDE CHILDREN'S HOSPITAL TOLEDO, LLC Toledo, OH facility · fee schedule · outpatient | 1 | $66 | $66 | — | — | — | $66 – $66 |
| 9 | Nationwide Children's Hospital Columbus, OH facility · fee schedule · outpatient | 1 | $63 | $63 | — | — | — | $63 – $63 |
| 10 | Nationwide Children's Hospital Columbus, OH professional · percent of total billed charges · outpatientfrom % of charges | 1 | $63 | $63 | — | — | — | $63 – $63 |
| 11 | North Adams Regional Hospital North Adams, MA facility · fee schedule · outpatient | 1 | $65 | $68 | $12 | 18% | — | $55 – $85 |
| 12 | The Toledo Hospital Maumee, OH facility · fee schedule · outpatient | 1 | $66 | $66 | — | — | — | $66 – $66 |
← Payers reporting HCPCS V5264 · Snapshot 20261111T120946Z-9134e7f7