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
FOAM DRG >16<=48 SQ IN W/BDR
Low
$0
Average
$27
Median
$24
High
$81
Each hospital's average Ambetter rate, under the methodology and billing class chosen below.
10 hospitals; the 90th percentile is 36.7× 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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11 hospital rates
iThe hospitals that file a Ambetter 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 | Grady Memorial Hospital Atlanta, GA facility · percent of total billed charges · outpatientfrom % of charges | 1 | $50 | $50 | — | — | — | $50 – $50 |
| 2 | Hospital Authority of Colquitt County Moultrie, GA fee schedule · both | 1 | $22 | $22 | $1 | 5% | — | $21 – $23 |
| 3 | Pittsburg Hospital, LLC Pittsburg, TX facility · percent of total billed charges · bothfrom % of charges | 1 | $12 | $12 | — | — | — | $12 – $12 |
| 4 | Quitman Hospital, LLC Quitman, TX facility · percent of total billed charges · bothfrom % of charges | 1 | $2 | $2 | — | — | — | $2 – $2 |
| 5 | The Methodist Hospitals, Inc. Gary, IN facility · fee schedule · outpatient | 1 | $0 | $0 | — | — | — | $0 – $0 |
| 6 | University Hospitals Health System Geneva, OH facility · percent of total billed charges · outpatientfrom % of charges | 1 | $20 | $20 | — | — | — | $20 – $20 |
| 7 | University Hospitals Health System Conneaut, OH facility · percent of total billed charges · outpatientfrom % of charges | 1 | $30 | $30 | — | — | — | $30 – $30 |
| 8 | University Hospitals Health System Cleveland, OH facility · percent of total billed charges · inpatientfrom % of charges | 1 | $31 | $31 | — | — | — | $31 – $31 |
| 9 | University Hospitals Health System Cleveland, OH facility · percent of total billed charges · outpatientfrom % of charges | 1 | $31 | $31 | — | — | — | $31 – $31 |
| 10 | University Medical Center of Southern Nevada Las Vegas, NV fee schedule · outpatient | 1 | $81 | $81 | — | — | — | $81 – $81 |
| 11 | VALLEY REGIONAL HOSPITAL CLAREMONT, NH percent of total billed charges · bothfrom % of charges | 1 | $25 | $26 | $12 | 46% | — | $13 – $40 |
← Payers reporting HCPCS A6213 · Snapshot 20261111T120946Z-9134e7f7