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
$1
Average
$17
Median
$17
High
$57
Each hospital's average WellCare rate, under the methodology and billing class chosen below.
31 hospitals; the 90th percentile is 5.2× 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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31 hospital rates
iThe hospitals that file a WellCare 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 | AMH Cath Labs LLC Arlington, TX percent of total billed charges · outpatientfrom % of charges | 1 | $4 | $9 | $13 | 141% | — | $2 – $50 |
| 2 | ANGEL MEDICAL CENTER Franklin, NC percent of total billed charges · outpatientfrom % of charges | 1 | $4 | $4 | — | — | — | $4 – $4 |
| 3 | BLUE RIDGE REGIONAL HOSPITAL Spruce Pine, NC percent of total billed charges · outpatientfrom % of charges | 1 | $4 | $4 | — | — | — | $4 – $4 |
| 4 | Children's Hospital of the King's Daughters Norfolk, VA facility · percent of total billed charges · outpatientfrom % of charges | 1 | $15 | $17 | $6 | 34% | — | $11 – $30 |
| 5 | HIGHLANDS-CASHIERS HOSPITAL Highlands, NC percent of total billed charges · outpatientfrom % of charges | 1 | $8 | $8 | — | — | — | $8 – $8 |
| 6 | MISSION HOSPITAL Arden, NC percent of total billed charges · outpatientfrom % of charges | 1 | $5 | $5 | — | — | — | $5 – $5 |
| 7 | MISSION HOSPITAL MCDOWELL Marion, NC percent of total billed charges · outpatientfrom % of charges | 1 | $3 | $3 | — | — | — | $3 – $3 |
| 8 | PRISMA HEALTH BAPTIST COLUMBIA HOSPITAL COLUMBIA, SC percent of total billed charges · bothfrom % of charges | 1 | $24 | $23 | $1 | 6% | — | $21 – $24 |
| 9 | PRISMA HEALTH BAPTIST EASLEY HOSPITAL EASLEY, SC percent of total billed charges · bothfrom % of charges | 1 | $24 | $23 | $1 | 6% | — | $21 – $24 |
| 10 | PRISMA HEALTH BAPTIST PARKRIDGE HOSPITAL COLUMBIA, SC percent of total billed charges · bothfrom % of charges | 1 | $24 | $23 | $1 | 6% | — | $21 – $24 |
| 11 | PRISMA HEALTH BLOUNT MEMORIAL HOSPITAL MARYVILLE, TN percent of total billed charges · bothfrom % of charges | 1 | $24 | $23 | $1 | 6% | — | $21 – $24 |
| 12 | PRISMA HEALTH GREENVILLE MEMORIAL HOSPITAL GREENVILLE, SC percent of total billed charges · bothfrom % of charges | 1 | $24 | $23 | $1 | 6% | — | $21 – $24 |
| 13 | PRISMA HEALTH GREER MEMORIAL HOSPITAL GREER, SC percent of total billed charges · bothfrom % of charges | 1 | $24 | $23 | $1 | 6% | — | $21 – $24 |
| 14 | PRISMA HEALTH HILLCREST HOSPITAL SIMPSONVILLE, SC percent of total billed charges · bothfrom % of charges | 1 | $24 | $23 | $1 | 6% | — | $21 – $24 |
| 15 | PRISMA HEALTH LAURENS COUNTY HOSPITAL CLINTON, SC percent of total billed charges · bothfrom % of charges | 1 | $24 | $23 | $1 | 6% | — | $21 – $24 |
| 16 | PRISMA HEALTH NORTH GREENVILLE LTACH HOSPITAL TRAVELERS REST, SC percent of total billed charges · bothfrom % of charges | 1 | $24 | $23 | $1 | 6% | — | $21 – $24 |
| 17 | PRISMA HEALTH OCONEE MEMORIAL HOSPITAL SENECA, SC percent of total billed charges · bothfrom % of charges | 1 | $24 | $23 | $1 | 6% | — | $21 – $24 |
| 18 | PRISMA HEALTH PATEWOOD HOSPITAL GREENVILLE, SC percent of total billed charges · bothfrom % of charges | 1 | $24 | $23 | $1 | 6% | — | $21 – $24 |
| 19 | PRISMA HEALTH RICHLAND HOSPITAL COLUMBIA, SC percent of total billed charges · bothfrom % of charges | 1 | $24 | $23 | $1 | 6% | — | $21 – $24 |
| 20 | PRISMA HEALTH TUOMEY HOSPITAL SUMTER, SC percent of total billed charges · bothfrom % of charges | 1 | $24 | $23 | $1 | 6% | — | $21 – $24 |
| 21 | Pittsburg Hospital, LLC Pittsburg, TX facility · percent of total billed charges · bothfrom % of charges | 1 | $12 | $12 | — | — | — | $12 – $12 |
| 22 | Quitman Hospital, LLC Quitman, TX facility · percent of total billed charges · bothfrom % of charges | 1 | $1 | $1 | — | — | — | $1 – $1 |
| 23 | Springfield Hospital Springfield, VT fee schedule · outpatient | 1 | $57 | $57 | — | — | — | $57 – $57 |
| 24 | Sweetwater Hospital Association Sweetwater, TN fee schedule · both | 1 | $16 | $16 | $11 | 67% | — | $5 – $27 |
| 25 | TRANSYLVANIA REGIONAL HOSPITAL Brevard, NC percent of total billed charges · outpatientfrom % of charges | 1 | $5 | $5 | — | — | — | $5 – $5 |
← Payers reporting HCPCS A6213 · Snapshot 20261111T120946Z-9134e7f7