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
Xwrap hydro, per square centimeter (add-on, list separately in addition to primary procedure)
Low
$150
Average
$237
Median
$218
High
$351
Each hospital's average Ambetter rate, under the methodology and billing class chosen below.
31 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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31 hospital rates
iThe hospitals that file a Ambetter 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 | Good Samaritan Hospital Puyallup, WA fee schedule · outpatient | 1 | $285 | $285 | — | — | — | $285 – $285 |
| 2 | Hendrick Medical Center Brownwood, TX facility · case rate · outpatient | 1 | $284 | $284 | — | — | — | $284 – $284 |
| 3 | Indiana University Health Arnett Inc. Lafayette, IN fee schedule · outpatient | 1 | $218 | $218 | — | — | — | $218 – $218 |
| 4 | Indiana University Health Ball Memorial Hospital Inc. Muncie, IN fee schedule · outpatient | 1 | $218 | $218 | — | — | — | $218 – $218 |
| 5 | Indiana University Health Bloomington Inc. Bloomington, IN fee schedule · outpatient | 1 | $218 | $218 | — | — | — | $218 – $218 |
| 6 | Indiana University Health Inc. Martinsville, IN fee schedule · outpatient | 1 | $218 | $218 | — | — | — | $218 – $218 |
| 7 | Indiana University Health North Hospital Inc. Carmel, IN fee schedule · outpatient | 1 | $218 | $218 | — | — | — | $218 – $218 |
| 8 | Indiana University Health West Hospital Inc. Avon, IN fee schedule · outpatient | 1 | $218 | $218 | — | — | — | $218 – $218 |
| 9 | Inspira Medical Center Mullica Hill Hill, NJ fee schedule · outpatient | 1 | $287 | $287 | — | — | — | $287 – $287 |
| 10 | Inspira Medical Center Vineland Vineland, NJ fee schedule · outpatient | 1 | $287 | $287 | — | — | — | $287 – $287 |
| 11 | MultiCare Auburn Medical Center Auburn, WA fee schedule · outpatient | 1 | $283 | $283 | — | — | — | $283 – $283 |
| 12 | MultiCare Capital Medical Center Lacey, WA fee schedule · outpatient | 1 | $261 | $261 | — | — | — | $261 – $261 |
| 13 | MultiCare Covington Medical Center Covington, WA fee schedule · outpatient | 1 | $283 | $283 | — | — | — | $283 – $283 |
| 14 | MultiCare Deaconess Hospital Spokane, WA fee schedule · outpatient | 1 | $251 | $251 | — | — | — | $251 – $251 |
| 15 | MultiCare Valley Hospital Spokane Valley, WA fee schedule · outpatient | 1 | $251 | $251 | — | — | — | $251 – $251 |
| 16 | MultiCare Yakima Valley Memorial Hospital Association Union Gap, WA fee schedule · outpatient | 1 | $249 | $249 | — | — | — | $249 – $249 |
| 17 | New Liberty Hospital Corporation Liberty, MO facility · fee schedule · outpatient | 1 | $158 | $158 | — | — | — | $158 – $158 |
| 18 | SID Peterson Memorial Hospital Kerrville, TX facility · case rate · outpatient | 1 | $150 | $150 | — | — | — | $150 – $150 |
| 19 | Sarasota Memorial Hospital Sarasota, FL fee schedule · outpatient | 1 | $351 | $351 | — | — | — | $351 – $351 |
| 20 | Sarasota Memorial Hospital - Venice North Venice, FL fee schedule · outpatient | 1 | $351 | $351 | — | — | — | $351 – $351 |
| 21 | Tacoma General Allenmore Hospital Bremerton, WA fee schedule · outpatient | 1 | $285 | $285 | — | — | — | $285 – $285 |
| 22 | USA Health Children's & Women's Hospital Mobile, AL facility · case rate · outpatient | 1 | $153 | $153 | — | — | — | $153 – $153 |
| 23 | USA Health University Hospital Mobile, AL facility · case rate · outpatient | 1 | $153 | $153 | — | — | — | $153 – $153 |
| 24 | University Hospitals Health System Chardon, OH facility · fee schedule · outpatient | 1 | $212 | $212 | — | — | — | $212 – $212 |
| 25 | University Hospitals Health System Ravenna, OH facility · fee schedule · outpatient | 1 | $229 | $229 | — | — | — | $229 – $229 |
← Payers reporting HCPCS Q4408 · Snapshot 20261113T090226Z-3ce6c0b8