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
CAST SUP SHT ARM PED FBRGLAS
Low
$6
Average
$26
Median
$12
High
$304
Each hospital's average Tricare rate, under the methodology and billing class chosen below.
33 hospitals; the 90th percentile is 4.6× 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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36 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 | Aspirus Divine Savior Hospital Portage, WI fee schedule · both | 1 | $12 | $12 | — | — | — | $12 – $12 |
| 2 | Aspirus St. Luke’s Hospital Duluth, MN fee schedule · both | 1 | $12 | $12 | — | — | — | $12 – $12 |
| 3 | Canton-Potsdam Hospital Potsdam, NY facility · fee schedule · outpatient | 1 | $11 | $11 | — | — | — | $11 – $11 |
| 4 | Columbia Lutheran Charities Astoria, OR facility · percent of total billed charges · bothfrom % of charges | 1 | $9 | $9 | — | — | — | $9 – $9 |
| 5 | Covenant Medical Center Inc Waterloo, IA professional · percent of total billed charges · bothfrom % of charges | 1 | $20 | $20 | — | — | — | $20 – $20 |
| 6 | FORT LOUDOUN MEDICAL CENTER Lenoir City, TN fee schedule · outpatient | 1 | $12 | $12 | — | — | — | $12 – $12 |
| 7 | FORT SANDERS REGIONAL MEDICAL CENTER Knoxville, TN fee schedule · outpatient | 1 | $12 | $12 | — | — | — | $12 – $12 |
| 8 | GRITMAN MEDICAL CENTER INC Moscow, ID facility · fee schedule · both | 1 | $6 | $6 | — | — | — | $6 – $6 |
| 9 | Hospital Authority of Colquitt County Moultrie, GA fee schedule · both | 1 | $304 | $304 | — | — | — | $304 – $304 |
| 10 | Jefferson Health - Northeast Langhorne, PA facility · fee schedule · outpatient | 1 | $12 | $12 | — | — | — | $12 – $12 |
| 11 | Jefferson Health - Northeast Philadelphia, PA facility · fee schedule · outpatient | 1 | $12 | $12 | — | — | — | $12 – $12 |
| 12 | Jefferson Health - Northeast Philadelphia, PA facility · fee schedule · outpatient | 1 | $12 | $12 | — | — | — | $12 – $12 |
| 13 | Kennedy University Hospital, Inc Turnersville, NJ facility · fee schedule · outpatient | 1 | $12 | $12 | — | — | — | $12 – $12 |
| 14 | Kennedy University Hospital, Inc Cherry Hill, NJ facility · fee schedule · outpatient | 1 | $12 | $12 | — | — | — | $12 – $12 |
| 15 | Lansdale Hospital Corp Lansdale, PA facility · fee schedule · outpatient | 1 | $12 | $12 | — | — | — | $12 – $12 |
| 16 | Little Company of Mary Hospital of Indiana Inc Jasper, IN facility · case rate · outpatient | 1 | $10 | $10 | — | — | — | $10 – $10 |
| 17 | Little Company of Mary Hospital of Indiana Inc Jasper, IN professional · fee schedule · both | 1 | $12 | $12 | — | — | — | $12 – $12 |
| 18 | METHODIST MEDICAL CENTER OF OAK RIDGE Oak Ridge, TN fee schedule · outpatient | 1 | $12 | $12 | — | — | — | $12 – $12 |
| 19 | MORRISTOWN HAMBLEN HOSPITAL ASSOCIATION Morristown, TN fee schedule · outpatient | 1 | $12 | $12 | — | — | — | $12 – $12 |
| 20 | Mayo Clinic Health System Sparta, WI professional · fee schedule · outpatient | 1 | $12 | $12 | — | — | — | $12 – $12 |
| 21 | OCHSNER BAYOU LLC Raceland, LA percent of total billed charges · outpatientfrom % of charges | 1 | $7 | $7 | $0 | 5% | — | $7 – $8 |
| 22 | Ochsner American Legion Hospital, LLC Jennings, LA fee schedule · outpatient | 1 | $12 | $12 | — | — | — | $12 – $12 |
| 23 | PARKWEST MEDICAL CENTER Knoxville, TN fee schedule · outpatient | 1 | $12 | $12 | — | — | — | $12 – $12 |
| 24 | PARKWEST MEDICAL CENTER Louisville, TN fee schedule · outpatient | 1 | $12 | $12 | — | — | — | $12 – $12 |
| 25 | Pennsylvania Hospital of the University of Pennsylvania Health System Philadelphia, PA facility · fee schedule · outpatient | 1 | $59 | $59 | — | — | — | $59 – $59 |
← Payers reporting HCPCS Q4012 · Snapshot 20261111T120946Z-9134e7f7