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
$43
Median
$33
High
$230
Each hospital's average Blue Cross Blue Shield rate, under the methodology and billing class chosen below.
178 hospitals; the 90th percentile is 87.5× 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.
Filter by billing methodology
Filter by billing class
216 hospital rates
iThe hospitals that file a Blue Cross Blue Shield 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 | PRISMA HEALTH OCONEE MEMORIAL HOSPITAL SENECA, SC percent of total billed charges · bothfrom % of charges | 2 | $19 | $20 | $2 | 11% | 6–60 | $17 – $23 |
| 2 | Inspira Medical Center Mullica Hill Hill, NJ percent of total billed charges · outpatientfrom % of charges | 1 | $34 | $35 | $7 | 20% | 3–30 | $25 – $49 |
| 3 | Southeastern Regional Medical Center, Inc. Newnan, GA percent of total billed charges · outpatientfrom % of charges | 2 | $11 | $11 | $2 | 15% | 1–10 | $9 – $13 |
| 4 | VALLEY REGIONAL HOSPITAL CLAREMONT, NH percent of total billed charges · bothfrom % of charges | 4 | $18 | $30 | $15 | 49% | 1–10 | $10 – $49 |
| 5 | West Virginia Health Care Cooperative Inc. Summersville, WV facility · percent of total billed charges · outpatientfrom % of charges | 1 | $82 | $82 | — | — | 1–10 | $82 – $82 |
| 6 | West Virginia University Hospitals, Inc. Morgantown, WV facility · percent of total billed charges · outpatientfrom % of charges | 1 | $202 | $202 | — | — | 1–10 | $202 – $202 |
| 7 | ACADIAN MEDICAL CENTER EUNICE, LA fee schedule · both | 5 | $0 | $0 | — | — | — | $0 – $0 |
| 8 | ALBANY MEDICAL CENTER HOSPITAL Albany, NY facility · percent of total billed charges · outpatientfrom % of charges | 3 | $35 | $35 | — | — | — | $35 – $35 |
| 9 | ALEGENT CREIGHTON HEALTH Plainview, NE fee schedule · inpatient | 2 | $72 | $58 | $28 | 48% | — | $19 – $84 |
| 10 | ALEGENT CREIGHTON HEALTH Plainview, NE fee schedule · outpatient | 3 | $54 | $51 | $26 | 52% | — | $13 – $84 |
| 11 | ALEGENT HEALTH - MERCY HOSPITAL, CORNING IOWA Corning, IA fee schedule · outpatient | 1 | $33 | $27 | $13 | 47% | — | $9 – $38 |
| 12 | ALEGENT HEALTH COMMUNITY MEMORIAL HOSPITAL OF MISSOURI VALLEY, IOWA Missouri Valley, IA fee schedule · inpatient | 2 | $72 | $58 | $28 | 48% | — | $19 – $84 |
| 13 | ALEGENT HEALTH COMMUNITY MEMORIAL HOSPITAL OF MISSOURI VALLEY, IOWA Missouri Valley, IA fee schedule · outpatient | 2 | $72 | $58 | $28 | 48% | — | $19 – $84 |
| 14 | ALEGENT HEALTH MEMORIAL HOSPITAL, SCHUYLER Schuyler, NE fee schedule · inpatient | 2 | $72 | $58 | $28 | 48% | — | $19 – $84 |
| 15 | ALEGENT HEALTH MEMORIAL HOSPITAL, SCHUYLER Schuyler, NE fee schedule · outpatient | 3 | $45 | $49 | $27 | 55% | — | $11 – $84 |
| 16 | AMH Cath Labs LLC Arlington, TX percent of total billed charges · outpatientfrom % of charges | 5 | $17 | $44 | $74 | 171% | — | $2 – $438 |
| 17 | ANGEL MEDICAL CENTER Franklin, NC percent of total billed charges · outpatientfrom % of charges | 6 | $9 | $8 | $2 | 32% | — | $4 – $9 |
| 18 | Adventhealth Ottawa Ottawa, KS fee schedule · outpatient | 1 | $15 | $15 | — | — | — | $15 – $15 |
| 19 | Allina Health Systems Shakopee, MN facility · other · outpatient | 5 | $63 | $66 | $22 | 33% | — | $29 – $93 |
| 20 | Allina Health Systems MN; 1175 Nininger Road. Hastings, MN facility · other · outpatient | 2 | $60 | $60 | $3 | 4% | — | $57 – $63 |
| 21 | Allina Health Systems Owatonna, MN facility · other · outpatient | 5 | $63 | $66 | $22 | 33% | — | $29 – $93 |
| 22 | Allina Health Systems MN 55443; 550 Osborne Road NE. Fridley, MN facility · other · outpatient | 1 | $63 | $63 | — | — | — | $63 – $63 |
| 23 | Allina Health Systems Cambridge, MN facility · other · outpatient | 5 | $63 | $66 | $22 | 33% | — | $29 – $93 |
| 24 | Allina Health Systems Faribualt, MN facility · other · outpatient | 5 | $63 | $66 | $22 | 33% | — | $29 – $93 |
| 25 | Allina Health Systems River Falls, WI facility · fee schedule · outpatient | 2 | $60 | $60 | $56 | 93% | — | $4 – $116 |
← Payers reporting HCPCS A6213 · Snapshot 20261111T120946Z-9134e7f7