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
$109
Average
$280
Median
$127
High
$3.4k
Each hospital's average Tricare rate, under the methodology and billing class chosen below.
35 hospitals; the 90th percentile is 1.2× 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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35 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 | CLAIBORNE MEDICAL CENTER Tazewell, TN fee schedule · outpatient | 1 | $121 | $121 | — | — | — | $121 – $121 |
| 2 | CUMBERLAND MEDICAL CENTER, INC. Crossville, TN fee schedule · outpatient | 1 | $121 | $121 | — | — | — | $121 – $121 |
| 3 | Campbell County HMA, LLC LaFollette, TN facility · fee schedule · outpatient | 1 | $127 | $127 | — | — | — | $127 – $127 |
| 4 | Canton-Potsdam Hospital Potsdam, NY facility · fee schedule · outpatient | 1 | $109 | $109 | — | — | — | $109 – $109 |
| 5 | Central Maine Medical Center Lewiston, ME fee schedule · outpatient | 1 | $127 | $127 | — | — | — | $127 – $127 |
| 6 | Cocke County HMA, LLC Newport, TN facility · fee schedule · outpatient | 1 | $127 | $127 | — | — | — | $127 – $127 |
| 7 | East Georgia Regional Medical Center LLC Statesboro, GA facility · fee schedule · outpatient | 1 | $127 | $127 | — | — | — | $127 – $127 |
| 8 | FORT LOUDOUN MEDICAL CENTER Lenoir City, TN fee schedule · outpatient | 1 | $113 | $113 | — | — | — | $113 – $113 |
| 9 | FORT SANDERS REGIONAL MEDICAL CENTER Knoxville, TN fee schedule · outpatient | 1 | $113 | $113 | — | — | — | $113 – $113 |
| 10 | Gadsden Regional Medical Center LLC Gadsden, AL facility · fee schedule · outpatient | 1 | $127 | $127 | — | — | — | $127 – $127 |
| 11 | HSA PGH LLC Hialeah, FL facility · percent of total billed charges · outpatientfrom % of charges | 1 | $127 | $127 | — | — | — | $127 – $127 |
| 12 | Hospital Authority of Colquitt County Moultrie, GA fee schedule · both | 1 | $3.4k | $3.4k | $2.3k | 68% | — | $1.1k – $5.7k |
| 13 | Jefferson County HMA LLC Jefferson City, TN facility · fee schedule · outpatient | 1 | $127 | $127 | — | — | — | $127 – $127 |
| 14 | Kaleida Health Buffalo, NY fee schedule · outpatient | 1 | $148 | $148 | — | — | — | $148 – $148 |
| 15 | Kaweah Health Medical Center Visalia, CA facility · fee schedule · outpatient | 1 | $127 | $127 | — | — | — | $127 – $127 |
| 16 | Kaweah Health Mental Health Hospital Visalia, CA facility · fee schedule · outpatient | 1 | $1.3k | $2.3k | $2.0k | 84% | — | $412 – $5.5k |
| 17 | LECONTE MEDICAL CENTER Sevierville, TN fee schedule · outpatient | 1 | $121 | $121 | — | — | — | $121 – $121 |
| 18 | METHODIST MEDICAL CENTER OF OAK RIDGE Oak Ridge, TN fee schedule · outpatient | 1 | $113 | $113 | — | — | — | $113 – $113 |
| 19 | MORRISTOWN HAMBLEN HOSPITAL ASSOCIATION Morristown, TN fee schedule · outpatient | 1 | $113 | $113 | — | — | — | $113 – $113 |
| 20 | Metro Knoxville HMA LLC Powell, TN facility · fee schedule · outpatient | 1 | $127 | $127 | — | — | — | $127 – $127 |
| 21 | Metro Knoxville HMA LLC Knoxville, TN facility · fee schedule · outpatient | 1 | $127 | $127 | — | — | — | $127 – $127 |
| 22 | Newark-Wayne Community Hospital Newark, NY facility · fee schedule · outpatient | 1 | $121 | $121 | — | — | — | $121 – $121 |
| 23 | Northside Hospital, Inc. Lawrenceville, GA fee schedule · outpatient | 1 | $127 | $127 | — | — | — | $127 – $127 |
| 24 | Northside Hospital, Inc. Atlanta, GA fee schedule · outpatient | 1 | $127 | $127 | — | — | — | $127 – $127 |
| 25 | Northside Hospital, Inc. Cumming, GA fee schedule · outpatient | 1 | $127 | $127 | — | — | — | $127 – $127 |
← Payers reporting HCPCS Q4152 · Snapshot 20261111T120946Z-9134e7f7