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
Grft Sft Tiss Epicord 1x2cm (per Sq Cm)
Low
$109
Average
$965
Median
$127
High
$9.7k
Each hospital's average Tricare rate, under the methodology and billing class chosen below.
74 hospitals; the 90th percentile is 27.3× 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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81 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 | Bay Park Community Hospital Oregon, OH facility · fee schedule · outpatient | 1 | $127 | $127 | — | — | — | $127 – $127 |
| 2 | Bay Park Community Hospital Oregon, OH professional · fee schedule · outpatient | 1 | $233 | $233 | — | — | — | $233 – $233 |
| 3 | Bullhead City Hospital Corporation City, AZ facility · fee schedule · outpatient | 1 | $127 | $127 | — | — | — | $127 – $127 |
| 4 | CLAIBORNE MEDICAL CENTER Tazewell, TN fee schedule · outpatient | 1 | $121 | $121 | — | — | — | $121 – $121 |
| 5 | CUMBERLAND MEDICAL CENTER, INC. Crossville, TN fee schedule · outpatient | 1 | $121 | $121 | — | — | — | $121 – $121 |
| 6 | Campbell County HMA, LLC LaFollette, TN facility · fee schedule · outpatient | 1 | $127 | $127 | — | — | — | $127 – $127 |
| 7 | Canton-Potsdam Hospital Potsdam, NY facility · fee schedule · outpatient | 1 | $109 | $109 | — | — | — | $109 – $109 |
| 8 | Central Maine Medical Center Lewiston, ME fee schedule · outpatient | 1 | $127 | $127 | — | — | — | $127 – $127 |
| 9 | Cocke County HMA, LLC Newport, TN facility · fee schedule · outpatient | 1 | $127 | $127 | — | — | — | $127 – $127 |
| 10 | Coulee Medical Center Grand Coulee, WA facility · percent of total billed charges · inpatientfrom % of charges | 1 | $3.2k | $3.2k | $1.4k | 43% | — | $1.8k – $4.5k |
| 11 | Doylestown Hospital Doylestown, PA facility · fee schedule · outpatient | 1 | $127 | $127 | — | — | — | $127 – $127 |
| 12 | FORT LOUDOUN MEDICAL CENTER Lenoir City, TN fee schedule · outpatient | 1 | $113 | $113 | — | — | — | $113 – $113 |
| 13 | FORT SANDERS REGIONAL MEDICAL CENTER Knoxville, TN fee schedule · both | 1 | $113 | $113 | — | — | — | $113 – $113 |
| 14 | Fisher-Titus Medical Center Norwalk, OH facility · percent of total billed charges · inpatientfrom % of charges | 1 | $2.9k | $2.9k | $1.1k | 40% | — | $1.7k – $4.0k |
| 15 | Fisher-Titus Medical Center Norwalk, OH facility · percent of total billed charges · outpatientfrom % of charges | 1 | $2.7k | $2.7k | $1.1k | 40% | — | $1.6k – $3.8k |
| 16 | GUTHRIE CORTLAND MEDICAL CENTER Cortland, NY facility · other · outpatient | 1 | $1.3k | $1.3k | — | — | — | $1.3k – $1.3k |
| 17 | Garfield County, a political subdivision of the State of Utah, DBA Intermountain Health Garfield Memorial Hospital Panguitch, UT facility · percent of total billed charges · inpatientfrom % of charges | 1 | $402 | $531 | $182 | 34% | — | $402 – $788 |
| 18 | Garfield County, a political subdivision of the State of Utah, DBA Intermountain Health Garfield Memorial Hospital Panguitch, UT facility · percent of total billed charges · outpatientfrom % of charges | 1 | $338 | $446 | $153 | 34% | — | $338 – $663 |
| 19 | Granbury Hospital Corporation Granbury, TX facility · fee schedule · outpatient | 1 | $127 | $127 | — | — | — | $127 – $127 |
| 20 | Holy Cross Germantown Hospital Germantown, MD facility · percent of total billed charges · bothfrom % of charges | 1 | $585 | $791 | $303 | 38% | — | $569 – $1.2k |
| 21 | Holy Cross Hospital-Silver Spring Silver Spring, MD facility · percent of total billed charges · bothfrom % of charges | 1 | $488 | $664 | $249 | 38% | — | $488 – $1.0k |
| 22 | Jefferson County HMA LLC Jefferson City, TN facility · fee schedule · outpatient | 1 | $127 | $127 | — | — | — | $127 – $127 |
| 23 | Kaleida Health Buffalo, NY fee schedule · outpatient | 1 | $148 | $148 | — | — | — | $148 – $148 |
| 24 | Kaweah Health Medical Center Visalia, CA facility · fee schedule · outpatient | 1 | $127 | $127 | — | — | — | $127 – $127 |
| 25 | Kaweah Health Mental Health Hospital Visalia, CA facility · fee schedule · outpatient | 1 | $298 | $298 | — | — | — | $298 – $298 |
← Payers reporting HCPCS Q4187 · Snapshot 20261111T120946Z-9134e7f7