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
$5
Average
$32
Median
$23
High
$257
Each hospital's average Anthem rate, under the methodology and billing class chosen below.
104 hospitals; the 90th percentile is 10.6× 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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155 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 | University of Wisconsin Hospital and Clinics Authority WI 53718; 1675 Highland Ave Madison, WI percent of total billed chargesfrom % of charges | 4 | $54 | $57 | $24 | 42% | 8–80 | $19 – $110 |
| 2 | Shelby County Memorial Hospital Assocation Sidney, OH facility · percent of total billed charges · bothfrom % of charges | 3 | $86 | $77 | $36 | 47% | 2–20 | $16 – $120 |
| 3 | AKRON GENERAL MEDICAL CENTER Akron, OH facility · case rate · outpatient | 1 | $15 | $15 | — | — | — | $15 – $15 |
| 4 | ARTHUR G JAMES CANCER HOSPITAL AND RESEARCH INSTITUTE Columbus, OH percent of total billed charges · inpatientfrom % of charges | 2 | $62 | $62 | $10 | 16% | — | $52 – $72 |
| 5 | ARTHUR G JAMES CANCER HOSPITAL AND RESEARCH INSTITUTE Columbus, OH percent of total billed charges · outpatientfrom % of charges | 3 | $51 | $51 | $18 | 35% | — | $29 – $73 |
| 6 | Acadia Hospital Bangor, ME facility · fee schedule · outpatient | 2 | $8 | $8 | $1 | 12% | — | $7 – $9 |
| 7 | Acadia Hospital Bangor, ME professional · fee schedule · outpatient | 1 | $7 | $7 | — | — | — | $7 – $7 |
| 8 | Adena Fayette Medical Center Washington Court House, OH facility · percent of total billed charges · inpatientfrom % of charges | 3 | $64 | $60 | $10 | 16% | — | $47 – $70 |
| 9 | Adena Fayette Medical Center Washington Court House, OH facility · percent of total billed charges · outpatientfrom % of charges | 4 | $58 | $54 | $16 | 31% | — | $28 – $70 |
| 10 | Adena Health System Chillicothe, OH facility · percent of total billed charges · inpatientfrom % of charges | 1 | $68 | $68 | — | — | — | $68 – $68 |
| 11 | Adena Health System Chillicothe, OH facility · percent of total billed charges · outpatientfrom % of charges | 5 | $60 | $59 | $8 | 13% | — | $49 – $68 |
| 12 | Aurora BayCare Medical Center Green Bay, WI percent of total billed charges · inpatientfrom % of charges | 1 | $49 | $49 | $11 | 22% | — | $38 – $60 |
| 13 | Aurora BayCare Medical Center Green Bay, WI percent of total billed charges · outpatientfrom % of charges | 3 | $40 | $40 | $11 | 27% | — | $27 – $60 |
| 14 | Aurora Lakeland Medical Center Elkhorn, WI percent of total billed charges · inpatientfrom % of charges | 1 | $38 | $34 | $22 | 64% | — | $8 – $64 |
| 15 | Aurora Lakeland Medical Center Elkhorn, WI percent of total billed charges · outpatientfrom % of charges | 3 | $29 | $28 | $19 | 67% | — | $6 – $64 |
| 16 | Aurora Medical Center Bay Area Marinette, WI percent of total billed charges · inpatientfrom % of charges | 1 | $14 | $14 | $7 | 51% | — | $7 – $21 |
| 17 | Aurora Medical Center Bay Area Marinette, WI percent of total billed charges · outpatientfrom % of charges | 3 | $12 | $12 | $6 | 51% | — | $6 – $21 |
| 18 | Aurora Medical Center Burlington Burlington, WI percent of total billed charges · inpatientfrom % of charges | 1 | $23 | $23 | $15 | 65% | — | $8 – $38 |
| 19 | Aurora Medical Center Burlington Burlington, WI percent of total billed charges · outpatientfrom % of charges | 3 | $18 | $19 | $13 | 67% | — | $6 – $38 |
| 20 | Aurora Medical Center Fond du Lac Fond Du Lac, WI percent of total billed charges · inpatientfrom % of charges | 1 | $38 | $38 | — | — | — | $38 – $38 |
| 21 | Aurora Medical Center Fond du Lac Fond Du Lac, WI percent of total billed charges · outpatientfrom % of charges | 3 | $29 | $32 | $5 | 15% | — | $27 – $38 |
| 22 | Aurora Medical Center Grafton Grafton, WI percent of total billed charges · inpatientfrom % of charges | 1 | $27 | $35 | $25 | 70% | — | $12 – $74 |
| 23 | Aurora Medical Center Grafton Grafton, WI percent of total billed charges · outpatientfrom % of charges | 3 | $22 | $29 | $21 | 73% | — | $8 – $74 |
| 24 | Aurora Medical Center Kenosha Kenosha, WI percent of total billed charges · inpatientfrom % of charges | 1 | $20 | $31 | $27 | 85% | — | $5 – $78 |
| 25 | Aurora Medical Center Kenosha Kenosha, WI percent of total billed charges · outpatientfrom % of charges | 3 | $16 | $26 | $23 | 88% | — | $4 – $78 |
← Payers reporting HCPCS A6213 · Snapshot 20261111T120946Z-9134e7f7