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
Fa Brace Wrist Fabrifoam Sm Lt
Low
$2
Average
$171
Median
$214
High
$247
Each hospital's average Tricare rate, under the methodology and billing class chosen below.
50 hospitals; the 90th percentile is 31.8× 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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51 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 | Ascension Seton Austin, TX fee schedule · outpatient | 1 | $179 | $179 | — | — | — | $179 – $179 |
| 2 | Beaufort Memorial Hospital Beaufort, SC facility · fee schedule · outpatient | 1 | $225 | $225 | — | — | — | $225 – $225 |
| 3 | Butler Healthcare Providers_ DBA Butler Memorial Hospital Butler, PA facility · fee schedule · outpatient | 1 | $201 | $201 | — | — | — | $201 – $201 |
| 4 | Canton-Potsdam Hospital Potsdam, NY facility · fee schedule · outpatient | 1 | $193 | $193 | — | — | — | $193 – $193 |
| 5 | Central Maine Medical Center Lewiston, ME fee schedule · outpatient | 1 | $232 | $232 | — | — | — | $232 – $232 |
| 6 | Charleston Area Medical Center Charleston, WV percent of total billed charges · bothfrom % of charges | 1 | $80 | $80 | — | — | — | $80 – $80 |
| 7 | Clarion Hospital Clarion, PA facility · fee schedule · outpatient | 1 | $201 | $201 | — | — | — | $201 – $201 |
| 8 | Columbia Lutheran Charities Astoria, OR facility · percent of total billed charges · bothfrom % of charges | 1 | $127 | $127 | — | — | — | $127 – $127 |
| 9 | FORT LOUDOUN MEDICAL CENTER Lenoir City, TN fee schedule · outpatient | 1 | $229 | $229 | — | — | — | $229 – $229 |
| 10 | FORT SANDERS REGIONAL MEDICAL CENTER Knoxville, TN fee schedule · outpatient | 1 | $229 | $229 | — | — | — | $229 – $229 |
| 11 | IHC Health Services Inc., DBA Intermountain Primary Children's Hospital City, UT facility · fee schedule · outpatient | 1 | $213 | $213 | — | — | — | $213 – $213 |
| 12 | IHC Health Services Inc., DBA Intermountain Primary Children's Hospital Lehi, UT facility · fee schedule · outpatient | 1 | $213 | $213 | — | — | — | $213 – $213 |
| 13 | Kaweah Health Medical Center Visalia, CA facility · fee schedule · outpatient | 1 | $180 | $195 | $52 | 27% | — | $104 – $262 |
| 14 | Kaweah Health Mental Health Hospital Visalia, CA facility · fee schedule · outpatient | 1 | $180 | $243 | $161 | 66% | — | $104 – $697 |
| 15 | Lake Charles Memorial Hospital Charles., LA fee schedule · outpatient | 1 | $216 | $216 | — | — | — | $216 – $216 |
| 16 | Little Company of Mary Hospital of Indiana Inc Jasper, IN facility · case rate · outpatient | 1 | $228 | $228 | — | — | — | $228 – $228 |
| 17 | MCLAREN BAY REGION CITY, MI fee schedule | 1 | $224 | $224 | — | — | — | $224 – $224 |
| 18 | MCLAREN CENTRAL MICHIGAN PLEASANT, MI fee schedule | 1 | $202 | $202 | — | — | — | $202 – $202 |
| 19 | MCLAREN GREATER LANSING LANSING, MI fee schedule | 1 | $213 | $213 | — | — | — | $213 – $213 |
| 20 | MCLAREN OAKLAND PONTIAC, MI fee schedule | 1 | $202 | $202 | — | — | — | $202 – $202 |
| 21 | METHODIST MEDICAL CENTER OF OAK RIDGE Oak Ridge, TN fee schedule · outpatient | 1 | $229 | $229 | — | — | — | $229 – $229 |
| 22 | MORRISTOWN HAMBLEN HOSPITAL ASSOCIATION Morristown, TN fee schedule · outpatient | 1 | $229 | $229 | — | — | — | $229 – $229 |
| 23 | Mayo Clinic Health System Sparta, WI professional · fee schedule · outpatient | 1 | $49 | $49 | — | — | — | $49 – $49 |
| 24 | Mayo Clinic Health System Cannon Falls 55009-5003 facility · fee schedule · both | 1 | $233 | $233 | — | — | — | $233 – $233 |
| 25 | Mercy Hospital Columbus Columbus, KS facility · percent of total billed charges · outpatientfrom % of charges | 1 | $7 | $7 | — | — | — | $7 – $7 |
← Payers reporting HCPCS L3931 · Snapshot 20261111T120946Z-9134e7f7