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
$13
Average
$18
Median
$14
High
$53
Each hospital's average Optum rate, under the methodology and billing class chosen below.
15 hospitals; the 90th percentile is 1.8× 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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15 hospital rates
iThe hospitals that file a Optum 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 | VALLEY REGIONAL HOSPITAL CLAREMONT, NH percent of total billed charges · bothfrom % of charges | 1 | $11 | $17 | $8 | 51% | 1–10 | $11 – $29 |
| 2 | AKRON GENERAL MEDICAL CENTER Akron, OH facility · case rate · outpatient | 1 | $13 | $13 | — | — | — | $13 – $13 |
| 3 | CLEVELAND CLINIC CHILDREN'S HOSPITAL FOR REHABILITATION Cleveland, OH facility · case rate · outpatient | 1 | $24 | $24 | — | — | — | $24 – $24 |
| 4 | CLEVELAND CLINIC HEALTH SYSTEM - EAST REGION Mentor, OH facility · case rate · outpatient | 1 | $14 | $14 | — | — | — | $14 – $14 |
| 5 | CLEVELAND CLINIC HEALTH SYSTEM - EAST REGION Euclid, OH facility · case rate · outpatient | 1 | $15 | $15 | — | — | — | $15 – $15 |
| 6 | CLEVELAND CLINIC HEALTH SYSTEM - EAST REGION Warrensville Heights, OH facility · case rate · outpatient | 1 | $15 | $15 | — | — | — | $15 – $15 |
| 7 | Fairview Hospital Cleveland, OH facility · case rate · outpatient | 1 | $14 | $14 | — | — | — | $14 – $14 |
| 8 | Fisher-Titus Medical Center Norwalk, OH facility · fee schedule · outpatient | 1 | $13 | $13 | — | — | — | $13 – $13 |
| 9 | Holy Name Teaneck, NJ facility · fee schedule · outpatient | 1 | $14 | $14 | — | — | — | $14 – $14 |
| 10 | LODI COMMUNITY HOSPITAL Lodi, OH facility · case rate · outpatient | 1 | $23 | $23 | — | — | — | $23 – $23 |
| 11 | LUTHERAN HOSPITAL Cleveland, OH facility · case rate · outpatient | 1 | $13 | $13 | — | — | — | $13 – $13 |
| 12 | MARYMOUNT HOSPITAL INC Garfield Heights, OH facility · case rate · outpatient | 1 | $13 | $13 | — | — | — | $13 – $13 |
| 13 | MEDINA HOSPITAL Medina, OH facility · case rate · outpatient | 1 | $14 | $14 | — | — | — | $14 – $14 |
| 14 | The Cleveland Clinic Foundation Brunswick, OH facility · case rate · outpatient | 1 | $17 | $17 | — | — | — | $17 – $17 |
| 15 | University of Wisconsin Hospital and Clinics Authority WI 53718; 1675 Highland Ave Madison, WI percent of total billed chargesfrom % of charges | 1 | $55 | $53 | $16 | 29% | — | $30 – $73 |
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