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
$51
Median
$23
High
$936
Each hospital's average UnitedHealthcare rate, under the methodology and billing class chosen below.
337 hospitals; the 90th percentile is 9.9× 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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460 hospital rates
iThe hospitals that file a UnitedHealthcare 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 | ACADIAN MEDICAL CENTER EUNICE, LA percent of total billed charges · bothfrom % of charges | 2 | $22 | $22 | $19 | 88% | 39–48 | $3 – $41 |
| 2 | GRMC, Inc. Oakland, MD percent of total billed charges · bothfrom % of charges | 2 | $11 | $16 | $9 | 56% | 19–73 | $7 – $35 |
| 3 | Texas Health Arlington Memorial Hospital Arlington, TX percent of total billed charges · outpatientfrom % of charges | 3 | $15 | $39 | $65 | 167% | 12–120 | $2 – $291 |
| 4 | Tufts Medical Center BOSTON, MA other · both | 1 | $17 | $29 | $21 | 70% | 8–80 | $10 – $59 |
| 5 | Aurora Medical Center Grafton Grafton, WI percent of total billed charges · outpatientfrom % of charges | 5 | $22 | $27 | $19 | 73% | 4–40 | $8 – $74 |
| 6 | Aurora West Allis Medical Center West Allis, WI percent of total billed charges · outpatientfrom % of charges | 5 | $51 | $52 | $36 | 70% | 4–40 | $10 – $133 |
| 7 | University of Wisconsin Hospital and Clinics Authority WI 53718; 1675 Highland Ave Madison, WI percent of total billed chargesfrom % of charges | 3 | $60 | $61 | $22 | 36% | 4–40 | $27 – $98 |
| 8 | North Oaks Medical Center Drive. Hammond, LA percent of total billed charges · bothfrom % of charges | 3 | $0 | $0 | — | — | 3–30 | $0 – $0 |
| 9 | Hudson Hospital Hudson, WI facility · percent of total billed charges · bothfrom % of charges | 1 | $89 | $89 | $51 | 57% | 2–20 | $38 – $140 |
| 10 | Shelby County Memorial Hospital Assocation Sidney, OH facility · percent of total billed charges · bothfrom % of charges | 2 | $82 | $83 | $11 | 13% | 2–20 | $69 – $97 |
| 11 | Arkansas Childrens Hospital Little Rock, AR facility · percent of total billed charges · outpatientfrom % of charges | 1 | $75 | $75 | — | — | 1–10 | $75 – $75 |
| 12 | CHRISTUS Hospital - Orange Orange, TX percent of total billed charges · outpatientfrom % of charges | 1 | $11 | $11 | — | — | 1–10 | $11 – $11 |
| 13 | CHRISTUS West Beaumont Beaumont, TX percent of total billed charges · outpatientfrom % of charges | 1 | $11 | $11 | — | — | 1–10 | $11 – $11 |
| 14 | Christus Health Southeast Texas Beaumont, TX percent of total billed charges · outpatientfrom % of charges | 1 | $11 | $11 | — | — | 1–10 | $11 – $11 |
| 15 | Christus Health Southeast Texas Port Arthur, TX percent of total billed charges · outpatientfrom % of charges | 1 | $11 | $11 | — | — | 1–10 | $11 – $11 |
| 16 | Southeast Texas Orthopedic Specialty Center Port Arthur, TX percent of total billed charges · outpatientfrom % of charges | 1 | $11 | $11 | — | — | 1–10 | $11 – $11 |
| 17 | VALLEY REGIONAL HOSPITAL CLAREMONT, NH percent of total billed charges · bothfrom % of charges | 1 | $18 | $31 | $15 | 48% | 1–10 | $17 – $48 |
| 18 | WINNESHIEK MEDICAL CENTER Decorah, IA percent of total billed charges · outpatientfrom % of charges | 1 | $24 | $24 | — | — | 1–10 | $24 – $24 |
| 19 | AHS Claremore Hospital, LLC Claremore, OK facility · percent of total billed charges · bothfrom % of charges | 2 | $12 | $12 | — | — | — | $12 – $12 |
| 20 | AHS Cushing Hospital, LLC Cushing, OK facility · percent of total billed charges · bothfrom % of charges | 1 | $23 | $29 | $15 | 51% | — | $15 – $50 |
| 21 | AKRON GENERAL MEDICAL CENTER Akron, OH facility · case rate · outpatient | 1 | $15 | $15 | — | — | — | $15 – $15 |
| 22 | ALBANY MEDICAL CENTER HOSPITAL Albany, NY facility · percent of total billed charges · bothfrom % of charges | 1 | $51 | $51 | — | — | — | $51 – $51 |
| 23 | ALBANY MEDICAL CENTER HOSPITAL Albany, NY facility · percent of total billed charges · inpatientfrom % of charges | 1 | $48 | $48 | — | — | — | $48 – $48 |
| 24 | ALEGENT CREIGHTON HEALTH Papillion, NE fee schedule · outpatient | 2 | $16 | $29 | $24 | 82% | — | $4 – $66 |
| 25 | ALEGENT CREIGHTON HEALTH Plainview, NE fee schedule · inpatient | 1 | $74 | $59 | $28 | 47% | — | $20 – $84 |
← Payers reporting HCPCS A6213 · Snapshot 20261111T120946Z-9134e7f7