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
4X6CM DERMAPURE ALLOGRAFT
Low
$43
Average
$670
Median
$224
High
$5.9k
Each hospital's average Ambetter rate, under the methodology and billing class chosen below.
143 hospitals; the 90th percentile is 13.0× 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.
Filter by billing methodology
Filter by billing class
154 hospital rates
iThe hospitals that file a Ambetter 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 | BURLESON ST. JOSEPH HEALTH CENTER OF CALDWELL, TEXAS Caldwell, TX fee schedule · outpatient | 1 | $3.5k | $3.5k | — | — | — | $3.5k – $3.5k |
| 2 | Bartow Regional Medical Center Bartow, FL facility · percent of total billed charges · inpatientfrom % of charges | 2 | $4k | $5.1k | $2.9k | 58% | — | $2.4k – $11.3k |
| 3 | Bartow Regional Medical Center Bartow, FL facility · percent of total billed charges · outpatientfrom % of charges | 2 | $4k | $5.1k | $2.9k | 58% | — | $2.4k – $11.3k |
| 4 | Baxter County Regional Hospital, Inc. Home, AR facility · fee schedule · outpatient | 1 | $169 | $169 | — | — | — | $169 – $169 |
| 5 | Baycare Hospital Wesley Chapel Chapel, FL facility · percent of total billed charges · inpatientfrom % of charges | 2 | $4k | $5.1k | $2.9k | 58% | — | $2.4k – $11.3k |
| 6 | Baycare Hospital Wesley Chapel Chapel, FL facility · percent of total billed charges · outpatientfrom % of charges | 2 | $4k | $5.1k | $2.9k | 58% | — | $2.4k – $11.3k |
| 7 | Baylor Scott & White All Saints Medical Center - Fort Worth Fort Worth, TX facility · fee schedule · outpatient | 1 | $269 | $269 | — | — | — | $269 – $269 |
| 8 | Baylor Scott & White Heart and Vascular Hospital - Dallas Dallas, TX facility · fee schedule · outpatient | 1 | $269 | $269 | — | — | — | $269 – $269 |
| 9 | Baylor Scott & White Medical Center - Centennial Frisco, TX facility · fee schedule · outpatient | 1 | $269 | $269 | — | — | — | $269 – $269 |
| 10 | Baylor Scott & White Medical Center - Frisco at PGA Parkway Frisco, TX facility · fee schedule · outpatient | 1 | $269 | $269 | — | — | — | $269 – $269 |
| 11 | Baylor Scott & White Medical Center - Grapevine Grapevine, TX facility · fee schedule · outpatient | 1 | $269 | $269 | — | — | — | $269 – $269 |
| 12 | Baylor Scott & White Medical Center - Irving Irving, TX facility · fee schedule · outpatient | 1 | $269 | $269 | — | — | — | $269 – $269 |
| 13 | Baylor Scott & White Medical Center - Lake Pointe Rowlett, TX facility · fee schedule · outpatient | 1 | $269 | $269 | — | — | — | $269 – $269 |
| 14 | Baylor Scott & White Medical Center - McKinney McKinney, TX facility · fee schedule · outpatient | 1 | $269 | $269 | — | — | — | $269 – $269 |
| 15 | Baylor Scott & White Medical Center - Plano Plano, TX facility · fee schedule · outpatient | 1 | $269 | $269 | — | — | — | $269 – $269 |
| 16 | Baylor Scott & White Medical Center at Waxahachie Waxahachie, TX facility · fee schedule · outpatient | 1 | $269 | $269 | — | — | — | $269 – $269 |
| 17 | Baylor Scott & White The Heart Hospital - Denton Denton, TX facility · fee schedule · outpatient | 1 | $269 | $269 | — | — | — | $269 – $269 |
| 18 | Baylor Scott & White The Heart Hospital - Plano Plano, TX facility · fee schedule · outpatient | 1 | $269 | $269 | — | — | — | $269 – $269 |
| 19 | Baylor University Medical Center Dallas, TX facility · fee schedule · outpatient | 1 | $269 | $269 | — | — | — | $269 – $269 |
| 20 | Bradley Medical Center Cleveland, TN facility · fee schedule · outpatient | 1 | $194 | $194 | — | — | — | $194 – $194 |
| 21 | Bristol Regional Medical Center BRISTOL, VA fee schedule · both | 1 | $257 | $257 | — | — | — | $257 – $257 |
| 22 | Brunswick Community Hospital, LLC Bolivia, NC fee schedule · outpatient | 1 | $300 | $300 | — | — | — | $300 – $300 |
| 23 | Campbell County HMA, LLC LaFollette, TN facility · fee schedule · outpatient | 1 | $224 | $224 | — | — | — | $224 – $224 |
| 24 | Cocke County HMA, LLC Newport, TN facility · fee schedule · outpatient | 1 | $224 | $224 | — | — | — | $224 – $224 |
| 25 | Dickenson Community Hospital CLINTWOOD, VA percent of total billed charges · bothfrom % of charges | 1 | $346 | $346 | — | — | — | $346 – $346 |
← Payers reporting HCPCS Q4152 · Snapshot 20261111T120946Z-9134e7f7