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
Fo W/O Joint Custom T1
Low
$14
Average
$224
Median
$228
High
$544
Each hospital's average Tricare rate, under the methodology and billing class chosen below.
87 hospitals; the 90th percentile is 1.3× 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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96 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 | $186 | $186 | — | — | — | $186 – $186 |
| 2 | Ascension Seton Austin, TX fee schedule · outpatient | 1 | $186 | $186 | — | — | — | $186 – $186 |
| 3 | Ascension Seton Austin, TX fee schedule · outpatient | 1 | $186 | $186 | — | — | — | $186 – $186 |
| 4 | Ascension Seton Luling, TX fee schedule · outpatient | 1 | $186 | $186 | — | — | — | $186 – $186 |
| 5 | Ascension Seton Burnet, TX fee schedule · outpatient | 1 | $186 | $186 | — | — | — | $186 – $186 |
| 6 | Ascension Seton Smithville, TX fee schedule · outpatient | 1 | $186 | $186 | — | — | — | $186 – $186 |
| 7 | Ascension Seton Bastrop, TX fee schedule · outpatient | 1 | $186 | $186 | — | — | — | $186 – $186 |
| 8 | Ascension Seton Austin, TX fee schedule · outpatient | 1 | $186 | $186 | — | — | — | $186 – $186 |
| 9 | Aspen Valley Hospital District Aspen, CO facility · percent of total billed charges · bothfrom % of charges | 4 | $222 | $270 | $82 | 30% | — | $222 – $412 |
| 10 | Beaufort Memorial Hospital Beaufort, SC facility · fee schedule · outpatient | 1 | $235 | $235 | — | — | — | $235 – $235 |
| 11 | Butler Healthcare Providers_ DBA Butler Memorial Hospital Butler, PA facility · fee schedule · outpatient | 1 | $228 | $228 | — | — | — | $228 – $228 |
| 12 | Canton-Potsdam Hospital Potsdam, NY facility · fee schedule · outpatient | 1 | $210 | $210 | — | — | — | $210 – $210 |
| 13 | CentraState Medical Center Freehold Township, NJ fee schedule · both | 2 | $217 | $217 | $11 | 5% | — | $205 – $228 |
| 14 | CentraState Medical Center Freehold Township, NJ fee schedule · outpatient | 2 | $217 | $217 | $11 | 5% | — | $205 – $228 |
| 15 | Central Maine Medical Center Lewiston, ME fee schedule · outpatient | 1 | $233 | $233 | — | — | — | $233 – $233 |
| 16 | Charleston Area Medical Center Charleston, WV percent of total billed charges · bothfrom % of charges | 1 | $14 | $14 | — | — | — | $14 – $14 |
| 17 | Chilton Medical Center Pompton Plains, NJ fee schedule · both | 2 | $224 | $224 | $5 | 2% | — | $219 – $228 |
| 18 | Chilton Medical Center Pompton Plains, NJ fee schedule · outpatient | 2 | $224 | $224 | $5 | 2% | — | $219 – $228 |
| 19 | Clarion Hospital Clarion, PA facility · fee schedule · outpatient | 1 | $228 | $228 | — | — | — | $228 – $228 |
| 20 | Columbia Lutheran Charities Astoria, OR facility · percent of total billed charges · bothfrom % of charges | 1 | $141 | $141 | — | — | — | $141 – $141 |
| 21 | Conway Regional Medical Center Conway, AR facility · fee schedule · outpatient | 1 | $543 | $544 | $12 | 2% | — | $531 – $558 |
| 22 | Crestview Hospital Corporation Crestview, FL facility · fee schedule · outpatient | 1 | $228 | $228 | — | — | — | $228 – $228 |
| 23 | EAST BATON ROUGE MEDICAL CENTER, LLC Baton Rouge, LA fee schedule · outpatient | 1 | $235 | $235 | — | — | — | $235 – $235 |
| 24 | FORT LOUDOUN MEDICAL CENTER Lenoir City, TN fee schedule · both | 1 | $240 | $240 | — | — | — | $240 – $240 |
| 25 | FORT SANDERS REGIONAL MEDICAL CENTER Knoxville, TN fee schedule · both | 1 | $240 | $240 | — | — | — | $240 – $240 |
← Payers reporting HCPCS L3933 · Snapshot 20261111T120946Z-9134e7f7