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 SKIN 8X3CM AMNIOBAND 24SQ CM ALLOGRAFT
Low
$109
Average
$960
Median
$142
High
$5.4k
Each hospital's average Tricare rate, under the methodology and billing class chosen below.
62 hospitals; the 90th percentile is 28.8× 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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62 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 | Armstrong County Memorial Hospital Kittanning, PA facility · fee schedule · outpatient | 1 | $127 | $127 | — | — | — | $127 – $127 |
| 2 | CLAIBORNE MEDICAL CENTER Tazewell, TN fee schedule · outpatient | 1 | $121 | $121 | — | — | — | $121 – $121 |
| 3 | CORNING HOSPITAL Corning, NY facility · other · outpatient | 1 | $711 | $711 | — | — | — | $711 – $711 |
| 4 | CUMBERLAND MEDICAL CENTER, INC. Crossville, TN fee schedule · outpatient | 1 | $121 | $121 | — | — | — | $121 – $121 |
| 5 | Campbell County HMA, LLC LaFollette, TN facility · fee schedule · outpatient | 1 | $127 | $127 | — | — | — | $127 – $127 |
| 6 | Canton-Potsdam Hospital Potsdam, NY facility · fee schedule · outpatient | 1 | $109 | $109 | — | — | — | $109 – $109 |
| 7 | CentraState Medical Center Freehold Township, NJ other · outpatient | 2 | $2.1k | $2.1k | — | — | — | $2.1k – $2.1k |
| 8 | Central Maine Medical Center Lewiston, ME fee schedule · outpatient | 1 | $127 | $127 | — | — | — | $127 – $127 |
| 9 | Chilton Medical Center Pompton Plains, NJ other · outpatient | 2 | $2.1k | $2.1k | — | — | — | $2.1k – $2.1k |
| 10 | Cocke County HMA, LLC Newport, TN facility · fee schedule · outpatient | 1 | $127 | $127 | — | — | — | $127 – $127 |
| 11 | FORT LOUDOUN MEDICAL CENTER Lenoir City, TN fee schedule · outpatient | 1 | $113 | $113 | — | — | — | $113 – $113 |
| 12 | FORT SANDERS REGIONAL MEDICAL CENTER Knoxville, TN fee schedule · outpatient | 1 | $113 | $113 | — | — | — | $113 – $113 |
| 13 | GLENS FALLS HOSPITAL INC Falls, NY professional · fee schedule · outpatient | 4 | $136 | $136 | — | — | — | $136 – $136 |
| 14 | GUTHRIE CORTLAND MEDICAL CENTER Cortland, NY facility · other · outpatient | 1 | $220 | $220 | — | — | — | $220 – $220 |
| 15 | Granbury Hospital Corporation Granbury, TX facility · fee schedule · outpatient | 1 | $127 | $127 | — | — | — | $127 – $127 |
| 16 | HOULTON REGIONAL HOSPITAL HOULTON, ME percent of total billed charges · bothfrom % of charges | 1 | $1.4k | $1.7k | $646 | 38% | — | $1.2k – $2.8k |
| 17 | HSA PGH LLC Hialeah, FL facility · percent of total billed charges · outpatientfrom % of charges | 1 | $127 | $127 | — | — | — | $127 – $127 |
| 18 | Hackettstown Medical Center Hackettstown, NJ other · outpatient | 2 | $2.0k | $2.0k | — | — | — | $2.0k – $2.0k |
| 19 | Holy Cross Germantown Hospital Germantown, MD facility · percent of total billed charges · bothfrom % of charges | 1 | $389 | $392 | $77 | 20% | — | $276 – $524 |
| 20 | Holy Cross Hospital-Silver Spring Silver Spring, MD facility · percent of total billed charges · bothfrom % of charges | 1 | $346 | $756 | $804 | 106% | — | $230 – $2.6k |
| 21 | Jefferson County HMA LLC Jefferson City, TN facility · fee schedule · outpatient | 1 | $127 | $127 | — | — | — | $127 – $127 |
| 22 | KAPLAN GENERAL HOSPITAL, INC ST, LA percent of total billed charges · outpatientfrom % of charges | 1 | $6.2k | $5.0k | $2.6k | 52% | — | $448 – $7.9k |
| 23 | Kaleida Health Buffalo, NY fee schedule · outpatient | 1 | $148 | $148 | — | — | — | $148 – $148 |
| 24 | LECONTE MEDICAL CENTER Sevierville, TN fee schedule · outpatient | 1 | $121 | $121 | — | — | — | $121 – $121 |
| 25 | Las Cruces Medical Center LLC Las Cruces, NM facility · fee schedule · outpatient | 1 | $127 | $127 | — | — | — | $127 – $127 |
← Payers reporting HCPCS Q4151 · Snapshot 20261111T120946Z-9134e7f7