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
AFO PLASTIC
Low
$6
Average
$219
Median
$267
High
$579
Each hospital's average Tricare rate, under the methodology and billing class chosen below.
100 hospitals; the 90th percentile is 7.9× 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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103 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 | Affinity Hospital LLC Birmingham, AL facility · fee schedule · outpatient | 1 | $258 | $258 | — | — | — | $258 – $258 |
| 2 | Ascension Seton Austin, TX fee schedule · outpatient | 1 | $281 | $281 | — | — | — | $281 – $281 |
| 3 | Ascension Seton Smithville, TX fee schedule · outpatient | 1 | $281 | $281 | — | — | — | $281 – $281 |
| 4 | Ascension Seton Bastrop, TX fee schedule · outpatient | 1 | $281 | $281 | — | — | — | $281 – $281 |
| 5 | Beaufort Memorial Hospital Beaufort, SC facility · fee schedule · outpatient | 1 | $267 | $267 | — | — | — | $267 – $267 |
| 6 | Butler Healthcare Providers_ DBA Butler Memorial Hospital Butler, PA facility · fee schedule · outpatient | 1 | $267 | $267 | — | — | — | $267 – $267 |
| 7 | Campbell County HMA, LLC LaFollette, TN facility · fee schedule · outpatient | 1 | $258 | $258 | — | — | — | $258 – $258 |
| 8 | Canton-Potsdam Hospital Potsdam, NY facility · fee schedule · outpatient | 1 | $245 | $245 | — | — | — | $245 – $245 |
| 9 | Central Maine Medical Center Lewiston, ME fee schedule · outpatient | 1 | $314 | $314 | — | — | — | $314 – $314 |
| 10 | Charleston Area Medical Center Charleston, WV percent of total billed charges · bothfrom % of charges | 1 | $537 | $579 | $261 | 45% | — | $224 – $1.1k |
| 11 | Clarion Hospital Clarion, PA facility · fee schedule · outpatient | 1 | $267 | $267 | — | — | — | $267 – $267 |
| 12 | Cocke County HMA, LLC Newport, TN facility · fee schedule · outpatient | 1 | $258 | $258 | — | — | — | $258 – $258 |
| 13 | Crestview Hospital Corporation Crestview, FL facility · fee schedule · outpatient | 1 | $258 | $258 | — | — | — | $258 – $258 |
| 14 | Doylestown Hospital Doylestown, PA facility · fee schedule · outpatient | 1 | $175 | $175 | — | — | — | $175 – $175 |
| 15 | Dukes Health System LLC Peru, IN facility · fee schedule · outpatient | 1 | $107 | $70 | $45 | 65% | — | $14 – $107 |
| 16 | FORT LOUDOUN MEDICAL CENTER Lenoir City, TN fee schedule · outpatient | 1 | $272 | $272 | — | — | — | $272 – $272 |
| 17 | FORT SANDERS REGIONAL MEDICAL CENTER Knoxville, TN fee schedule · outpatient | 1 | $272 | $272 | — | — | — | $272 – $272 |
| 18 | Garfield County, a political subdivision of the State of Utah, DBA Intermountain Health Garfield Memorial Hospital Panguitch, UT facility · percent of total billed charges · inpatientfrom % of charges | 1 | $324 | $324 | — | — | — | $324 – $324 |
| 19 | Garfield County, a political subdivision of the State of Utah, DBA Intermountain Health Garfield Memorial Hospital Panguitch, UT facility · percent of total billed charges · outpatientfrom % of charges | 1 | $272 | $272 | — | — | — | $272 – $272 |
| 20 | HMA Santa Rosa Medical Center LLC Milton, FL facility · fee schedule · outpatient | 1 | $92 | $92 | — | — | — | $92 – $92 |
| 21 | Holy Cross Germantown Hospital Germantown, MD facility · percent of total billed charges · bothfrom % of charges | 1 | $143 | $143 | $48 | 33% | — | $96 – $191 |
| 22 | Holy Cross Hospital-Silver Spring Silver Spring, MD facility · percent of total billed charges · bothfrom % of charges | 1 | $105 | $105 | $35 | 33% | — | $70 – $140 |
| 23 | IHC Health Services Inc., DBA Intermountain Primary Children's Hospital City, UT facility · fee schedule · outpatient | 1 | $291 | $291 | — | — | — | $291 – $291 |
| 24 | IHC Health Services Inc., DBA Intermountain Primary Children's Hospital Lehi, UT facility · fee schedule · outpatient | 1 | $291 | $291 | — | — | — | $291 – $291 |
| 25 | Jefferson County HMA LLC Jefferson City, TN facility · fee schedule · outpatient | 1 | $258 | $258 | — | — | — | $258 – $258 |
← Payers reporting HCPCS L1930 · Snapshot 20261111T120946Z-9134e7f7