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
$82
Average
$1.1k
Median
$477
High
$3.4k
Each hospital's average Medical Mutual rate, under the methodology and billing class chosen below.
28 hospitals; the 90th percentile is 32.0× 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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58 hospital rates
iThe hospitals that file a Medical Mutual 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 Health System Chillicothe, OH facility · fee schedule · outpatient | 1 | $119 | $119 | — | — | — | $119 – $119 |
| 2 | Beavercreek Medical Center Springfield, OH fee schedule · outpatient | 2 | $82 | $82 | $21 | 25% | — | $62 – $103 |
| 3 | Bethesda Hospital Inc. Lebanon, OH facility · fee schedule · outpatient | 1 | $124 | $124 | — | — | — | $124 – $124 |
| 4 | Dayton Osteopathic Hospital Dayton, OH fee schedule · outpatient | 2 | $82 | $82 | $21 | 25% | — | $62 – $103 |
| 5 | Fairfield Medical Center 401 N Ewing St facility · fee schedule · outpatient | 1 | $118 | $118 | — | — | — | $118 – $118 |
| 6 | Fairfield Medical Center 401 N Ewing St facility · percent of total billed charges · inpatientfrom % of charges | 2 | $187 | $193 | $48 | 25% | — | $132 – $265 |
| 7 | Fairfield Medical Center 401 N Ewing St facility · percent of total billed charges · outpatientfrom % of charges | 2 | $187 | $193 | $48 | 25% | — | $132 – $265 |
| 8 | Fort Hamilton Hospital Hamilton, OH fee schedule · outpatient | 2 | $82 | $82 | $21 | 25% | — | $62 – $103 |
| 9 | Greene Memorial Hospital Inc Xenia, OH fee schedule · outpatient | 2 | $82 | $82 | $21 | 25% | — | $62 – $103 |
| 10 | Kettering Medical Center Troy, OH fee schedule · outpatient | 2 | $82 | $82 | $21 | 25% | — | $62 – $103 |
| 11 | Kettering Medical Center Franklin, OH fee schedule · outpatient | 2 | $82 | $82 | $21 | 25% | — | $62 – $103 |
| 12 | Kettering Medical Center Middletown, OH fee schedule · outpatient | 2 | $82 | $82 | $21 | 25% | — | $62 – $103 |
| 13 | McCullough-Hyde Memorial Hospital, Inc. Oxford, OH facility · fee schedule · outpatient | 1 | $124 | $124 | — | — | — | $124 – $124 |
| 14 | Metrohealth System Parma, OH facility · fee schedule · outpatient | 2 | $84 | $185 | $162 | 88% | — | $61 – $468 |
| 15 | Pomerene Hospital Millersburg, OH other · both | 1 | $115 | $115 | — | — | — | $115 – $115 |
| 16 | Pomerene Hospital Millersburg, OH percent of total billed charges · bothfrom % of charges | 1 | $6.7k | $6.7k | $296 | 4% | — | $6.4k – $7.0k |
| 17 | Summa Health System Wadsworth, OH fee schedule · outpatient | 3 | $238 | $265 | $131 | 49% | — | $108 – $523 |
| 18 | The Good Samaritan Hospital of Cincinnati, OH Cincinnati, OH facility · fee schedule · outpatient | 1 | $124 | $124 | — | — | — | $124 – $124 |
| 19 | University Hospitals Health System Chardon, OH facility · fee schedule · outpatient | 4 | $130 | $136 | $16 | 12% | — | $118 – $159 |
| 20 | University Hospitals Health System Chardon, OH facility · percent of total billed charges · inpatientfrom % of charges | 5 | $2.4k | $2.5k | $1.3k | 49% | — | $575 – $4.9k |
| 21 | University Hospitals Health System Chardon, OH facility · percent of total billed charges · outpatientfrom % of charges | 5 | $2.4k | $2.3k | $1.3k | 57% | — | $388 – $4.9k |
| 22 | University Hospitals Health System Ravenna, OH facility · fee schedule · outpatient | 4 | $127 | $129 | $9 | 7% | — | $117 – $143 |
| 23 | University Hospitals Health System Ravenna, OH facility · percent of total billed charges · inpatientfrom % of charges | 5 | $2.4k | $2.6k | $1.3k | 49% | — | $587 – $4.9k |
| 24 | University Hospitals Health System Ravenna, OH facility · percent of total billed charges · outpatientfrom % of charges | 5 | $2.4k | $2.3k | $1.4k | 59% | — | $350 – $4.9k |
| 25 | University Hospitals Health System Chardon, OH facility · case rate · outpatient | 1 | $135 | $135 | — | — | — | $135 – $135 |
← Payers reporting HCPCS Q4152 · Snapshot 20261111T120946Z-9134e7f7