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
SUB BNGF FOAM 5CC
SUMMERFIELD, FL
See all hospitals reporting HCPCS C1763 →Price type
Hca Florida Ocala Hospital’s median price of $1.4k is 46% below the median hospital's median price ($2.6k), higher than 25% of the 1,482 hospitals reporting HCPCS C1763. The highlighted bar is where this hospital falls; shaded is the middle 50% of hospitals.
Negotiated rates from the hospital’s own file: 5 payers, 8 plan rates. A facility fee, a professional fee, a per diem and a case rate are different bills, so each is listed on its own. Open a payer to see it across hospitals.
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| # | |||||||
|---|---|---|---|---|---|---|---|
| 1 | Aetna mcr percent of total billed charges · outpatientfrom % of charges | $199 | $284 | $227 | 80% | — | $56 – $685 |
| 2 | Blue Cross Blue Shield mcrppo percent of total billed charges · outpatientfrom % of charges | $212 | $303 | $242 | 80% | — | $60 – $731 |
| 3 | Blue Cross Blue Shield mcrhmo percent of total billed charges · outpatientfrom % of charges | $213 | $304 | $243 | 80% | — | $60 – $733 |
| 4 | UnitedHealthcare optionsppo percent of total billed charges · outpatientfrom % of charges | $586 | $836 | $670 | 80% | — | $166 – $2.0k |
| 5 | Aetna asa percent of total billed charges · outpatientfrom % of charges | $1.0k | $1.4k | $1.2k | 80% | — | $286 – $3.5k |
| 6 | Molina hix percent of total billed charges · outpatientfrom % of charges | $1.1k | $1.5k | $1.2k | 80% | — | $305 – $3.7k |
| 7 | UnitedHealthcare globalbenefitplan percent of total billed charges · outpatientfrom % of charges | $1.5k | $2.2k | $1.7k | 80% | — | $428 – $5.2k |
| 8 | MultiPlan primary percent of total billed charges · outpatientfrom % of charges | $2.6k | $3.7k | $3.0k | 80% | — | $743 – $9.0k |
Last updated: Mar 1, 2026
See Surgical matrix graft, 8x16 cm (Matristem) pricing across every hospital in the network reporting it, or ask Claude or any MCP client directly — see how to connect.