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
$11
Average
$55
Median
$35
High
$255
Each hospital's average Kaiser rate, under the methodology and billing class chosen below.
36 hospitals; the 90th percentile is 10.3× 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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40 hospital rates
iThe hospitals that file a Kaiser 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 | KAISER FOUNDATION HOSPITAL - RIVERSIDE RIVERSIDE, CA percent of total billed charges · bothfrom % of charges | 3 | $8 | $11 | $6 | 50% | 733 | $7 – $19 |
| 2 | KAISER FOUNDATION HOSPITAL - SAN DIEGO - ZION SAN DIEGO, CA percent of total billed charges · bothfrom % of charges | 3 | $8 | $11 | $6 | 50% | 732 | $7 – $19 |
| 3 | KAISER FOUNDATION HOSPITAL - DOWNEY Downey, CA percent of total billed charges · bothfrom % of charges | 3 | $8 | $11 | $6 | 50% | 460 | $7 – $19 |
| 4 | KAISER FOUNDATION HOSPITAL - ORANGE COUNTY - IRVINE Irvine, CA percent of total billed charges · bothfrom % of charges | 3 | $8 | $11 | $6 | 50% | 454 | $7 – $19 |
| 5 | KAISER FOUNDATION HOSPITAL - WOODLAND HILLS WOODLAND HILLS, CA percent of total billed charges · bothfrom % of charges | 3 | $8 | $11 | $6 | 50% | 407 | $7 – $19 |
| 6 | KAISER FOUNDATION HOSPITAL - WEST LA LOS ANGELES, CA percent of total billed charges · bothfrom % of charges | 3 | $8 | $11 | $6 | 50% | 268 | $7 – $19 |
| 7 | KAISER FOUNDATION HOSPITAL - SOUTH BAY HARBOR CITY, CA percent of total billed charges · bothfrom % of charges | 3 | $8 | $11 | $6 | 50% | 197 | $7 – $19 |
| 8 | KAISER FOUNDATION HOSPITAL - ONTARIO ONTARIO, CA percent of total billed charges · bothfrom % of charges | 3 | $8 | $11 | $6 | 50% | 184 | $7 – $19 |
| 9 | KAISER FOUNDATION HOSPITAL - BALDWIN PARK BALDWIN PARK, CA percent of total billed charges · bothfrom % of charges | 3 | $8 | $11 | $6 | 50% | 164 | $7 – $19 |
| 10 | KAISER FOUNDATION HOSPITAL - MORENO VALLEY MORENO VALLEY, CA percent of total billed charges · bothfrom % of charges | 3 | $8 | $11 | $6 | 50% | 150–159 | $7 – $19 |
| 11 | KAISER FOUNDATION HOSPITAL - SAN MARCOS SAN MARCOS, CA percent of total billed charges · bothfrom % of charges | 3 | $8 | $11 | $6 | 50% | 138–147 | $7 – $19 |
| 12 | KAISER FOUNDATION HOSPITAL - FONTANA FONTANA, CA percent of total billed charges · bothfrom % of charges | 3 | $8 | $11 | $6 | 50% | 111 | $7 – $19 |
| 13 | KAISER FOUNDATION HOSPITAL - PANORAMA CITY PANORAMA CITY, CA percent of total billed charges · bothfrom % of charges | 3 | $8 | $11 | $6 | 50% | 110 | $7 – $19 |
| 14 | KAISER FOUNDATION HOSPITAL - LOS ANGELES LOS ANGELES, CA percent of total billed charges · bothfrom % of charges | 3 | $8 | $11 | $6 | 50% | 60–69 | $7 – $19 |
| 15 | KAISER FOUNDATION HOSPITAL - ORANGE COUNTY - ANAHEIM Anaheim, CA percent of total billed charges · bothfrom % of charges | 3 | $8 | $11 | $6 | 50% | 3–30 | $7 – $19 |
| 16 | BSA Hospital Amarillo, TX facility · percent of total billed charges · bothfrom % of charges | 1 | $40 | $64 | $58 | 92% | — | $22 – $190 |
| 17 | Central Georgia Rehabilitation LLC Macon, GA fee schedule · both | 1 | $37 | $37 | — | — | — | $37 – $37 |
| 18 | Grady Memorial Hospital Atlanta, GA facility · percent of total billed charges · inpatientfrom % of charges | 1 | $255 | $255 | — | — | — | $255 – $255 |
| 19 | Grady Memorial Hospital Atlanta, GA facility · percent of total billed charges · outpatientfrom % of charges | 1 | $255 | $255 | — | — | — | $255 – $255 |
| 20 | Harrington Cancer Center Amarillo, TX facility · percent of total billed charges · bothfrom % of charges | 1 | $33 | $39 | $18 | 47% | — | $22 – $67 |
| 21 | Hilo Benioff Medical Center Hilo, HI facility · percent of total billed charges · outpatientfrom % of charges | 2 | $83 | $83 | $9 | 11% | — | $74 – $91 |
| 22 | Honokaa Hospital and Skilled Nursing Facility Honokaa, HI facility · percent of total billed charges · inpatientfrom % of charges | 1 | $131 | $131 | — | — | — | $131 – $131 |
| 23 | Honokaa Hospital and Skilled Nursing Facility Honokaa, HI facility · percent of total billed charges · outpatientfrom % of charges | 3 | $110 | $105 | $23 | 22% | — | $74 – $131 |
| 24 | John Muir Health Concord, CA percent of total billed charges · bothfrom % of charges | 1 | $180 | $180 | — | — | — | $180 – $180 |
| 25 | KAPIOLANI MEDICAL CENTER FOR WOMEN & CHILDREN Honolulu, HI facility · percent of total billed charges · bothfrom % of charges | 1 | $118 | $118 | — | — | — | $118 – $118 |
← Payers reporting HCPCS A6213 · Snapshot 20261111T120946Z-9134e7f7