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
$48
Average
$238
Median
$121
High
$3.4k
Each hospital's average Caresource rate, under the methodology and billing class chosen below.
113 hospitals; the 90th percentile is 4.4× 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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127 hospital rates
iThe hospitals that file a Caresource 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 | Adena Fayette Medical Center Washington Court House, OH facility · case rate · outpatient | 1 | $254 | $254 | — | — | — | $254 – $254 |
| 2 | Adena Health System Chillicothe, OH facility · fee schedule · outpatient | 2 | $179 | $179 | $58 | 32% | — | $121 – $238 |
| 3 | Beavercreek Medical Center Springfield, OH fee schedule · outpatient | 1 | $190 | $190 | — | — | — | $190 – $190 |
| 4 | Berger Hospital Circleville, OH fee schedule · outpatient | 1 | $88 | $88 | — | — | — | $88 – $88 |
| 5 | Camden-Clark Memorial Hospital Corporation Parkersburg, WV facility · other · outpatient | 2 | $161 | $161 | $28 | 18% | — | $133 – $190 |
| 6 | Catawba Valley Medical Center Hickory, NC fee schedule · outpatient | 1 | $270 | $270 | — | — | — | $270 – $270 |
| 7 | City Hospital, Inc. Martinsburg, WV facility · other · outpatient | 1 | $190 | $190 | — | — | — | $190 – $190 |
| 8 | Clinton Memorial Hospital Wilmington, OH fee schedule · outpatient | 1 | $156 | $156 | — | — | — | $156 – $156 |
| 9 | Dayton Osteopathic Hospital Dayton, OH fee schedule · outpatient | 1 | $190 | $190 | — | — | — | $190 – $190 |
| 10 | Deaconess Hospital, Inc Newburgh, IN facility · case rate · outpatient | 1 | $49 | $49 | — | — | — | $49 – $49 |
| 11 | Doctors Hospital Columbus, OH fee schedule · outpatient | 1 | $88 | $88 | — | — | — | $88 – $88 |
| 12 | Dublin Methodist Hospital Dublin, OH fee schedule · outpatient | 1 | $88 | $88 | — | — | — | $88 – $88 |
| 13 | East Georgia Regional Medical Center LLC Statesboro, GA facility · fee schedule · outpatient | 2 | $168 | $168 | $46 | 27% | — | $123 – $214 |
| 14 | East Georgia Regional Medical Center LLC Statesboro, GA facility · percent of total billed charges · outpatientfrom % of charges | 1 | $26 | $26 | $15 | 58% | — | $11 – $41 |
| 15 | FAIRVIEW PARK HOSPITAL DUBLIN, GA fee schedule · outpatient | 1 | $55 | $55 | — | — | — | $55 – $55 |
| 16 | Fairfield Medical Center 401 N Ewing St facility · fee schedule · outpatient | 2 | $139 | $139 | $17 | 12% | — | $122 – $156 |
| 17 | Fort Hamilton Hospital Hamilton, OH fee schedule · outpatient | 1 | $191 | $191 | — | — | — | $191 – $191 |
| 18 | Grady Memorial Hospital Atlanta, GA professional · fee schedule · outpatient | 1 | $81 | $81 | — | — | — | $81 – $81 |
| 19 | Grady Memorial Hospital Delaware, OH fee schedule · outpatient | 2 | $105 | $105 | $16 | 16% | — | $88 – $121 |
| 20 | Grant Medical Center Columbus, OH fee schedule · outpatient | 1 | $88 | $88 | — | — | — | $88 – $88 |
| 21 | Greene Memorial Hospital Inc Xenia, OH fee schedule · outpatient | 1 | $188 | $188 | — | — | — | $188 – $188 |
| 22 | Greenfield Area Medical Center Greenfield, OH facility · case rate · outpatient | 1 | $254 | $254 | — | — | — | $254 – $254 |
| 23 | Grove City Methodist Grove City, OH fee schedule · outpatient | 1 | $88 | $88 | — | — | — | $88 – $88 |
| 24 | HCA FLORIDA BAYONET POINT HOSPITAL HUDSON, FL fee schedule · outpatient | 1 | $55 | $55 | — | — | — | $55 – $55 |
| 25 | HCA FLORIDA BLAKE HOSPITAL PALMETTO, FL fee schedule · outpatient | 1 | $55 | $55 | — | — | — | $55 – $55 |
← Payers reporting HCPCS Q4152 · Snapshot 20261111T120946Z-9134e7f7