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
$9
Average
$25
Median
$12
High
$170
Each hospital's average Highmark rate, under the methodology and billing class chosen below.
29 hospitals; the 90th percentile is 4.2× 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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48 hospital rates
iThe hospitals that file a Highmark 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 | GRMC, Inc. Oakland, MD percent of total billed charges · bothfrom % of charges | 3 | $10 | $15 | $9 | 56% | 6–60 | $7 – $33 |
| 2 | West Virginia Health Care Cooperative Inc. Summersville, WV facility · percent of total billed charges · outpatientfrom % of charges | 1 | $35 | $35 | — | — | 1–10 | $35 – $35 |
| 3 | ALLE-KISKI MEDICAL CENTER NATRONA HEIGHTS, PA fee schedule · inpatient | 11 | $11 | $11 | — | — | — | $11 – $11 |
| 4 | ALLE-KISKI MEDICAL CENTER NATRONA HEIGHTS, PA fee schedule · outpatient | 11 | $11 | $11 | — | — | — | $11 – $11 |
| 5 | Broaddus Hospital Association Inc Philippi, WV professional · fee schedule · both | 1 | $12 | $12 | — | — | — | $12 – $12 |
| 6 | CANONSBURG GENERAL HOSPITAL CANONSBURG, PA fee schedule · inpatient | 11 | $11 | $11 | — | — | — | $11 – $11 |
| 7 | CANONSBURG GENERAL HOSPITAL CANONSBURG, PA fee schedule · outpatient | 11 | $11 | $11 | — | — | — | $11 – $11 |
| 8 | Davis Medical Center Elkins, WV professional · fee schedule · both | 1 | $12 | $12 | — | — | — | $12 – $12 |
| 9 | GROVE CITY MEDICAL CENTER GROVE CITY, PA fee schedule · inpatient | 11 | $11 | $11 | — | — | — | $11 – $11 |
| 10 | GROVE CITY MEDICAL CENTER GROVE CITY, PA fee schedule · outpatient | 11 | $11 | $11 | — | — | — | $11 – $11 |
| 11 | Greenbrier Valley Medical Center Ronceverte, WV percent of total billed charges · bothfrom % of charges | 4 | $211 | $170 | $78 | 46% | — | $36 – $224 |
| 12 | JEFFERSON REGIONAL MEDICAL CENTER JEFFERSON HILLS, PA fee schedule · inpatient | 11 | $11 | $11 | — | — | — | $11 – $11 |
| 13 | JEFFERSON REGIONAL MEDICAL CENTER JEFFERSON HILLS, PA fee schedule · outpatient | 11 | $11 | $11 | — | — | — | $11 – $11 |
| 14 | SAINT VINCENT HEALTH CENTER ERIE, PA fee schedule · inpatient | 11 | $11 | $11 | — | — | — | $11 – $11 |
| 15 | SAINT VINCENT HEALTH CENTER ERIE, PA fee schedule · outpatient | 11 | $11 | $11 | — | — | — | $11 – $11 |
| 16 | STONEWALL JACKSON HOSPITAL Weston, WV fee schedule · outpatient | 1 | $9 | $9 | — | — | — | $9 – $9 |
| 17 | UPMC Altoona Altoona, PA facility · fee schedule · outpatient | 1 | $14 | $14 | — | — | — | $14 – $14 |
| 18 | UPMC Altoona Altoona, PA facility · percent of total billed charges · outpatientfrom % of charges | 1 | $9 | $9 | — | — | — | $9 – $9 |
| 19 | UPMC East Monroeville, PA facility · fee schedule · outpatient | 6 | $48 | $53 | $29 | 55% | — | $14 – $110 |
| 20 | UPMC East Monroeville, PA facility · percent of total billed charges · outpatientfrom % of charges | 1 | $16 | $16 | $1 | 3% | — | $16 – $17 |
| 21 | UPMC Hamot Erie, PA facility · fee schedule · outpatient | 3 | $43 | $42 | $22 | 53% | — | $14 – $68 |
| 22 | UPMC Hamot Erie, PA facility · percent of total billed charges · outpatientfrom % of charges | 1 | $11 | $11 | $2 | 18% | — | $9 – $13 |
| 23 | UPMC Horizon - Greenville Farrell, PA facility · fee schedule · outpatient | 2 | $40 | $40 | $4 | 10% | — | $36 – $44 |
| 24 | UPMC Horizon - Greenville Farrell, PA facility · percent of total billed charges · outpatientfrom % of charges | 2 | $12 | $12 | — | — | — | $12 – $12 |
| 25 | UPMC Jameson New Castle, PA facility · fee schedule · outpatient | 1 | $14 | $14 | — | — | — | $14 – $14 |
← Payers reporting HCPCS A6213 · Snapshot 20261111T120946Z-9134e7f7