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
Graft Split Face 1st 100 Sq Cm Chld
Low
$310
Average
$3.3k
Median
$3.3k
High
$14.2k
Each hospital's average Tricare rate, under the methodology and billing class chosen below.
154 hospitals; the 90th percentile is 6.0× 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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181 hospital rates
iThe hospitals that file a Tricare 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 | ACADIA GENERAL HOSPITAL, INC 1305 CROWLEY RAYNE HWY other · outpatient | 1 | $3.3k | $3.3k | — | — | — | $3.3k – $3.3k |
| 2 | ALBANY MEDICAL CENTER HOSPITAL Albany, NY professional · fee schedule · outpatient | 4 | $658 | $663 | $85 | 13% | — | $549 – $787 |
| 3 | Affinity Hospital LLC Birmingham, AL facility · fee schedule · outpatient | 1 | $11.0k | $11.0k | — | — | — | $11.0k – $11.0k |
| 4 | AnMed Health Anderson, SC professional · fee schedule · inpatient | 1 | $654 | $654 | — | — | — | $654 – $654 |
| 5 | AnMed Health Anderson, SC professional · fee schedule · outpatient | 1 | $654 | $654 | — | — | — | $654 – $654 |
| 6 | AnMed Health Cannon Pickens, SC professional · fee schedule · inpatient | 1 | $654 | $654 | — | — | — | $654 – $654 |
| 7 | AnMed Health Cannon Pickens, SC professional · fee schedule · outpatient | 1 | $654 | $654 | — | — | — | $654 – $654 |
| 8 | AnMed Piedmont Piedmont, SC professional · fee schedule · inpatient | 1 | $654 | $654 | — | — | — | $654 – $654 |
| 9 | AnMed Piedmont Piedmont, SC professional · fee schedule · outpatient | 1 | $798 | $798 | — | — | — | $798 – $798 |
| 10 | Anderson Hospital Maryville, IL facility · fee schedule · outpatient | 1 | $6.1k | $6.1k | — | — | — | $6.1k – $6.1k |
| 11 | Anderson Hospital Maryville, IL professional · other · outpatient | 1 | $821 | $821 | — | — | — | $821 – $821 |
| 12 | Ascension Cedar Park Park, TX fee schedule · outpatient | 1 | $2.1k | $2.1k | — | — | — | $2.1k – $2.1k |
| 13 | Ascension Seton Austin, TX fee schedule · outpatient | 1 | $2.1k | $2.1k | — | — | — | $2.1k – $2.1k |
| 14 | Ascension Seton Austin, TX fee schedule · outpatient | 1 | $2.1k | $2.1k | — | — | — | $2.1k – $2.1k |
| 15 | Ascension Seton Austin, TX fee schedule · outpatient | 1 | $2.1k | $2.1k | — | — | — | $2.1k – $2.1k |
| 16 | Ascension Seton Luling, TX fee schedule · outpatient | 1 | $2.1k | $2.1k | — | — | — | $2.1k – $2.1k |
| 17 | Ascension Seton Burnet, TX fee schedule · outpatient | 1 | $2.1k | $2.1k | — | — | — | $2.1k – $2.1k |
| 18 | Ascension Seton Smithville, TX fee schedule · outpatient | 1 | $2.1k | $2.1k | — | — | — | $2.1k – $2.1k |
| 19 | Ascension Seton Bastrop, TX fee schedule · outpatient | 1 | $2.1k | $2.1k | — | — | — | $2.1k – $2.1k |
| 20 | Ascension Seton Austin, TX fee schedule · outpatient | 1 | $2.1k | $2.1k | — | — | — | $2.1k – $2.1k |
| 21 | Ascension Via Christi Hospital Manhattan, Inc. Manhattan, KS fee schedule · both | 1 | $1.5k | $1.5k | — | — | — | $1.5k – $1.5k |
| 22 | Austin Center for Outpatient Surgery LP, DBA Northwest Hills Surgical Hospital Austin, TX fee schedule · outpatient | 1 | $2.1k | $2.1k | — | — | — | $2.1k – $2.1k |
| 23 | Beaufort Memorial Hospital Beaufort, SC facility · fee schedule · outpatient | 1 | $3.6k | $3.6k | — | — | — | $3.6k – $3.6k |
| 24 | Beaufort Memorial Hospital Beaufort, SC facility · percent of total billed charges · inpatientfrom % of charges | 1 | $481 | $481 | — | — | — | $481 – $481 |
| 25 | Bon Secours Community Hospital Jervis, NY facility · fee schedule · outpatient | 1 | $6.6k | $6.6k | — | — | — | $6.6k – $6.6k |
← Payers reporting CPT 15120 · Snapshot 20261112T124536Z-e251e855