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
Form Fit Ankle W/Speedlace
Low
$1
Average
$155
Median
$97
High
$10.8k
Each hospital's average Blue Cross Blue Shield rate, under the methodology and billing class chosen below.
622 hospitals; the 90th percentile is 3.2× 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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854 hospital rates
iThe hospitals that file a Blue Cross Blue Shield 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 | The Carle Foundation Hospital Urbana, IL percent of total billed charges · outpatientfrom % of charges | 2 | $49 | $50 | $10 | 20% | 164 | $27 – $88 |
| 2 | FHN Memorial Hospital Freeport, IL percent of total billed charges · outpatientfrom % of charges | 1 | $84 | $81 | $34 | 42% | 12–120 | $10 – $128 |
| 3 | North Carolina Baptist Hospital Bermuda Run, NC percent of total billed charges · outpatientfrom % of charges | 4 | $23 | $35 | $22 | 63% | 12–120 | $14 – $75 |
| 4 | Arkansas Childrens Hospital Little Rock, AR facility · percent of total billed charges · outpatientfrom % of charges | 1 | $27 | $27 | — | — | 5–50 | $27 – $27 |
| 5 | Arkansas Childrens Northwest Springdale, AR facility · percent of total billed charges · outpatientfrom % of charges | 1 | $27 | $28 | $2 | 7% | 5–50 | $27 – $32 |
| 6 | North Carolina Baptist Hospital Winston Salem, NC percent of total billed charges · outpatientfrom % of charges | 4 | $21 | $20 | $3 | 17% | 4–40 | $14 – $23 |
| 7 | Allina Health Systems Shakopee, MN facility · other · outpatient | 5 | $107 | $112 | $37 | 33% | 3–30 | $51 – $158 |
| 8 | Allina Health Systems Owatonna, MN facility · other · outpatient | 5 | $107 | $112 | $37 | 33% | 3–30 | $51 – $158 |
| 9 | Allina Health Systems Cambridge, MN facility · other · outpatient | 5 | $107 | $112 | $37 | 33% | 3–30 | $51 – $158 |
| 10 | Allina Health Systems Faribualt, MN facility · other · outpatient | 5 | $107 | $112 | $37 | 33% | 3–30 | $51 – $158 |
| 11 | Allina Health Systems Buffalo, MN facility · other · outpatient | 5 | $107 | $112 | $37 | 33% | 3–30 | $51 – $158 |
| 12 | Brunswick Community Hospital, LLC Bolivia, NC percent of total billed charges · outpatientfrom % of charges | 3 | $80 | $62 | $25 | 40% | 3–30 | $27 – $80 |
| 13 | Novant Health Matthews Medical Center LLC Matthews, NC percent of total billed charges · outpatientfrom % of charges | 3 | $26 | $160 | $189 | 118% | 3–30 | $26 – $428 |
| 14 | Novant Health Mint Hill Medical Center, LLC Charlotte, NC percent of total billed charges · outpatientfrom % of charges | 3 | $59 | $65 | $8 | 12% | 3–30 | $59 – $76 |
| 15 | North Carolina Baptist Hospital Winston Salem, NC other · outpatient | 1 | $105 | $105 | — | — | 1–10 | $105 – $105 |
| 16 | Novant Health Ballantyne Medical Center LLC Charlotte, NC percent of total billed charges · outpatientfrom % of charges | 1 | $40 | $40 | — | — | 1–10 | $40 – $40 |
| 17 | PRISMA HEALTH BAPTIST EASLEY HOSPITAL EASLEY, SC percent of total billed charges · bothfrom % of charges | 4 | $37 | $44 | $15 | 35% | 1–10 | $30 – $70 |
| 18 | PRISMA HEALTH GREENVILLE MEMORIAL HOSPITAL GREENVILLE, SC percent of total billed charges · bothfrom % of charges | 4 | $37 | $44 | $15 | 35% | 1–10 | $30 – $70 |
| 19 | St. Joseph's Hospital of Buckhannon, Inc. Buckhannon, WV facility · percent of total billed charges · outpatientfrom % of charges | 1 | $53 | $53 | — | — | 1–10 | $53 – $53 |
| 20 | ADVENTIST HEALTH CLEARLAKE HOSPITAL INC Clearlake, CA case rate · outpatient | 3 | $71 | $68 | $3 | 5% | — | $63 – $71 |
| 21 | ADVENTIST HEALTH CLEARLAKE HOSPITAL INC Clearlake, CA percent of total billed charges · outpatientfrom % of charges | 5 | $23 | $45 | $28 | 63% | — | $22 – $80 |
| 22 | ADVENTIST HEALTH MEDICAL CENTER TEHACHAPI Tehachapi, CA fee schedule · outpatient | 4 | $99 | $101 | $10 | 10% | — | $90 – $117 |
| 23 | ADVENTIST HEALTH MENDOCINO COAST Bragg, CA fee schedule · outpatient | 4 | $93 | $78 | $33 | 43% | — | $21 – $105 |
| 24 | ADVENTIST HEALTH TULARE Tulare, CA case rate · outpatient | 2 | $50 | $50 | $3 | 5% | — | $48 – $53 |
| 25 | ADVENTIST HEALTH TULARE Tulare, CA other · outpatient | 2 | $103 | $103 | — | — | — | $103 – $103 |
← Payers reporting HCPCS L1902 · Snapshot 20261111T120946Z-9134e7f7