GRAFT SKIN APLIGRAF 44 SQ CM ALLOGRAFT VENOUS LEG DIABETIC FOOT ULCER

Highmark pricing summary

Low

$25

Average

$367

Median

$111

High

$6.9k

Highmark rate distribution

Filter by billing methodology

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167 hospital rates

#		Plans
1	ALBANY MEDICAL CENTER HOSPITAL Albany, NY professional · fee schedule · outpatient	8	$32	$32	$2	6%	—	$30 – $34
2	ALLE-KISKI MEDICAL CENTER NATRONA HEIGHTS, PA fee schedule · inpatient	11	$38	$38	$1	2%	—	$35 – $38
3	ALLE-KISKI MEDICAL CENTER NATRONA HEIGHTS, PA fee schedule · outpatient	11	$38	$38	$1	2%	—	$35 – $38
4	Abington Memorial Hospital Abington, PA professional · fee schedule · both	1	$56	$56	—	—	—	$56 – $56
5	Appalachian Regional Healthcare, Inc. Hinton, WV percent of total billed charges · outpatientfrom % of charges	1	$85	$1.5k	$2.1k	146%	—	$13 – $6.4k
6	Armstrong County Memorial Hospital Kittanning, PA facility · fee schedule · outpatient	1	$127	$127	—	—	—	$127 – $127
7	Armstrong County Memorial Hospital Kittanning, PA facility · other · outpatient	4	$287	$257	$64	25%	—	$147 – $309
8	Armstrong County Memorial Hospital Kittanning, PA facility · percent of total billed charges · outpatientfrom % of charges	1	$272	$272	—	—	—	$272 – $272
9	Beebe Medical Center Inc. Lewes, DE facility · fee schedule · outpatient	1	$49	$49	—	—	—	$49 – $49
10	Broaddus Hospital Association Inc Philippi, WV professional · fee schedule · both	2	$73	$73	$37	51%	—	$36 – $111
11	Bryn Mawr Rehabilitation Hospital Malvern, PA facility · fee schedule · outpatient	1	$82	$82	$52	63%	—	$30 – $135
12	Butler Healthcare Providers_ DBA Butler Memorial Hospital Butler, PA facility · percent of total billed charges · outpatientfrom % of charges	3	$30	$30	—	—	—	$30 – $30
13	CANONSBURG GENERAL HOSPITAL CANONSBURG, PA fee schedule · inpatient	11	$38	$38	$1	2%	—	$35 – $38
14	CANONSBURG GENERAL HOSPITAL CANONSBURG, PA fee schedule · outpatient	11	$38	$38	$1	2%	—	$35 – $38
15	COLUMBIA MEMORIAL HOSPITAL Hudson, NY professional · fee schedule · outpatient	4	$32	$32	$2	6%	—	$30 – $34
16	Camden-Clark Memorial Hospital Corporation Parkersburg, WV facility · other · outpatient	1	$132	$132	—	—	—	$132 – $132
17	CentraState Medical Center Freehold Township, NJ other · outpatient	2	$2.0k	$2.0k	—	—	—	$2.0k – $2.0k
18	Champlain Valley Physicians Hospital Medical Center Plattsburgh, NY facility · fee schedule · outpatient	2	$53	$53	—	—	—	$53 – $53
19	Charleston Area Medical Center Charleston, WV percent of total billed charges · bothfrom % of charges	4	$261	$1.5k	$2.3k	155%	—	$79 – $7.0k
20	Chilton Medical Center Pompton Plains, NJ other · outpatient	2	$2.1k	$2.1k	—	—	—	$2.1k – $2.1k
21	City Hospital, Inc. Martinsburg, WV facility · other · outpatient	2	$131	$131	$1	0%	—	$130 – $132
22	Clarion Hospital Clarion, PA facility · percent of total billed charges · outpatientfrom % of charges	2	$54	$54	—	—	—	$54 – $54
23	Clifton Springs Hospital And Clinic Clifton Springs, NY facility · fee schedule · outpatient	1	$36	$36	—	—	—	$36 – $36
24	Davis Medical Center Elkins, WV facility · case rate · outpatient	1	$118	$118	—	—	—	$118 – $118
25	Davis Medical Center Elkins, WV professional · fee schedule · both	2	$76	$76	$40	53%	—	$36 – $116

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← Payers reporting HCPCS Q4101 · Snapshot 20261111T120946Z-9134e7f7

HCPCS Q4101

GRAFT SKIN APLIGRAF 44 SQ CM ALLOGRAFT VENOUS LEG DIABETIC FOOT ULCER

Highmark pricing summary

Low

$25

Average

$367

Median

$111

High

$6.9k

Highmark rate distribution

Filter by billing methodology

Filter by billing class

167 hospital rates

#		Plans
1	ALBANY MEDICAL CENTER HOSPITAL Albany, NY professional · fee schedule · outpatient	8	$32	$32	$2	6%	—	$30 – $34
2	ALLE-KISKI MEDICAL CENTER NATRONA HEIGHTS, PA fee schedule · inpatient	11	$38	$38	$1	2%	—	$35 – $38
3	ALLE-KISKI MEDICAL CENTER NATRONA HEIGHTS, PA fee schedule · outpatient	11	$38	$38	$1	2%	—	$35 – $38
4	Abington Memorial Hospital Abington, PA professional · fee schedule · both	1	$56	$56	—	—	—	$56 – $56
5	Appalachian Regional Healthcare, Inc. Hinton, WV percent of total billed charges · outpatientfrom % of charges	1	$85	$1.5k	$2.1k	146%	—	$13 – $6.4k
6	Armstrong County Memorial Hospital Kittanning, PA facility · fee schedule · outpatient	1	$127	$127	—	—	—	$127 – $127
7	Armstrong County Memorial Hospital Kittanning, PA facility · other · outpatient	4	$287	$257	$64	25%	—	$147 – $309
8	Armstrong County Memorial Hospital Kittanning, PA facility · percent of total billed charges · outpatientfrom % of charges	1	$272	$272	—	—	—	$272 – $272
9	Beebe Medical Center Inc. Lewes, DE facility · fee schedule · outpatient	1	$49	$49	—	—	—	$49 – $49
10	Broaddus Hospital Association Inc Philippi, WV professional · fee schedule · both	2	$73	$73	$37	51%	—	$36 – $111
11	Bryn Mawr Rehabilitation Hospital Malvern, PA facility · fee schedule · outpatient	1	$82	$82	$52	63%	—	$30 – $135
12	Butler Healthcare Providers_ DBA Butler Memorial Hospital Butler, PA facility · percent of total billed charges · outpatientfrom % of charges	3	$30	$30	—	—	—	$30 – $30
13	CANONSBURG GENERAL HOSPITAL CANONSBURG, PA fee schedule · inpatient	11	$38	$38	$1	2%	—	$35 – $38
14	CANONSBURG GENERAL HOSPITAL CANONSBURG, PA fee schedule · outpatient	11	$38	$38	$1	2%	—	$35 – $38
15	COLUMBIA MEMORIAL HOSPITAL Hudson, NY professional · fee schedule · outpatient	4	$32	$32	$2	6%	—	$30 – $34
16	Camden-Clark Memorial Hospital Corporation Parkersburg, WV facility · other · outpatient	1	$132	$132	—	—	—	$132 – $132
17	CentraState Medical Center Freehold Township, NJ other · outpatient	2	$2.0k	$2.0k	—	—	—	$2.0k – $2.0k
18	Champlain Valley Physicians Hospital Medical Center Plattsburgh, NY facility · fee schedule · outpatient	2	$53	$53	—	—	—	$53 – $53
19	Charleston Area Medical Center Charleston, WV percent of total billed charges · bothfrom % of charges	4	$261	$1.5k	$2.3k	155%	—	$79 – $7.0k
20	Chilton Medical Center Pompton Plains, NJ other · outpatient	2	$2.1k	$2.1k	—	—	—	$2.1k – $2.1k
21	City Hospital, Inc. Martinsburg, WV facility · other · outpatient	2	$131	$131	$1	0%	—	$130 – $132
22	Clarion Hospital Clarion, PA facility · percent of total billed charges · outpatientfrom % of charges	2	$54	$54	—	—	—	$54 – $54
23	Clifton Springs Hospital And Clinic Clifton Springs, NY facility · fee schedule · outpatient	1	$36	$36	—	—	—	$36 – $36
24	Davis Medical Center Elkins, WV facility · case rate · outpatient	1	$118	$118	—	—	—	$118 – $118
25	Davis Medical Center Elkins, WV professional · fee schedule · both	2	$76	$76	$40	53%	—	$36 – $116

Page 1 of 7

← Payers reporting HCPCS Q4101 · Snapshot 20261111T120946Z-9134e7f7