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
Shoe molded plastazote cust
Low
$20
Average
$99
Median
$47
High
$379
Each hospital's average Anthem rate, under the methodology and billing class chosen below.
45 hospitals; the 90th percentile is 8.1× 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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53 hospital rates
iThe hospitals that file a Anthem 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 | AKRON GENERAL MEDICAL CENTER Akron, OH facility · case rate · outpatient | 1 | $28 | $28 | — | — | — | $28 – $28 |
| 2 | AKRON GENERAL MEDICAL CENTER Akron, OH facility · percent of total billed charges · inpatientfrom % of charges | 1 | $227 | $227 | — | — | — | $227 – $227 |
| 3 | AKRON GENERAL MEDICAL CENTER Akron, OH facility · percent of total billed charges · outpatientfrom % of charges | 3 | $69 | $116 | $73 | 63% | — | $59 – $220 |
| 4 | Acadia Hospital Bangor, ME facility · fee schedule · outpatient | 2 | $75 | $75 | $9 | 12% | — | $65 – $84 |
| 5 | Acadia Hospital Bangor, ME professional · fee schedule · outpatient | 1 | $68 | $68 | — | — | — | $68 – $68 |
| 6 | Blue Hill Memorial Hospital Hill, ME professional · fee schedule · outpatient | 2 | $51 | $42 | $26 | 62% | — | $7 – $68 |
| 7 | Boulder Community Health Lafayette, CO professional · fee schedule · both | 2 | $25 | $25 | — | — | — | $25 – $25 |
| 8 | CLEVELAND CLINIC AVON HOSPITAL Avon, OH facility · case rate · outpatient | 1 | $27 | $27 | — | — | — | $27 – $27 |
| 9 | CLEVELAND CLINIC CHILDREN'S HOSPITAL FOR REHABILITATION Cleveland, OH facility · case rate · outpatient | 1 | $49 | $49 | — | — | — | $49 – $49 |
| 10 | CLEVELAND CLINIC HEALTH SYSTEM - EAST REGION Mentor, OH facility · case rate · outpatient | 1 | $30 | $30 | — | — | — | $30 – $30 |
| 11 | CLEVELAND CLINIC HEALTH SYSTEM - EAST REGION Euclid, OH facility · case rate · outpatient | 1 | $31 | $31 | — | — | — | $31 – $31 |
| 12 | CLEVELAND CLINIC HEALTH SYSTEM - EAST REGION Warrensville Heights, OH facility · case rate · outpatient | 1 | $32 | $32 | — | — | — | $32 – $32 |
| 13 | COMMUNITY HOSPITAL OF SAN BERNARDINO San Bernardino, CA fee schedule · inpatient | 1 | $166 | $166 | $22 | 13% | — | $144 – $188 |
| 14 | COMMUNITY HOSPITAL OF SAN BERNARDINO San Bernardino, CA fee schedule · outpatient | 3 | $236 | $217 | $82 | 38% | — | $108 – $308 |
| 15 | Charles A. Dean Memorial Hospital Greenville, ME professional · fee schedule · outpatient | 2 | $51 | $42 | $26 | 62% | — | $7 – $68 |
| 16 | Cleveland Clinic Mercy Hospital Canton, OH facility · case rate · outpatient | 1 | $27 | $27 | — | — | — | $27 – $27 |
| 17 | Covenant Medical Center Inc Saginaw, MI facility · fee schedule · outpatient | 1 | $221 | $221 | — | — | — | $221 – $221 |
| 18 | Covenant Medical Center Inc Saginaw, MI facility · fee schedule · outpatient | 1 | $221 | $221 | — | — | — | $221 – $221 |
| 19 | DIGNITY COMMUNITY CARE Glendale, CA fee schedule · inpatient | 3 | $546 | $475 | $229 | 48% | — | $144 – $713 |
| 20 | DIGNITY COMMUNITY CARE Glendale, CA fee schedule · outpatient | 1 | $90 | $90 | — | — | — | $90 – $90 |
| 21 | DIGNITY HEALTH Henderson, NV fee schedule · inpatient | 2 | $362 | $368 | $67 | 18% | — | $280 – $469 |
| 22 | DIGNITY HEALTH Henderson, NV fee schedule · inpatient | 2 | $362 | $368 | $67 | 18% | — | $280 – $469 |
| 23 | DIGNITY HEALTH San Bernardino, CA fee schedule · inpatient | 1 | $166 | $166 | $22 | 13% | — | $144 – $188 |
| 24 | DIGNITY HEALTH San Bernardino, CA fee schedule · outpatient | 5 | $242 | $230 | $75 | 33% | — | $108 – $323 |
| 25 | DIGNITY HEALTH Long Beach, CA fee schedule · inpatient | 1 | $133 | $133 | $18 | 13% | — | $115 – $150 |
← Payers reporting HCPCS L3253 · Snapshot 20261112T181611Z-3fa9fb76