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
Puraply 1 sq cm
Low
$43
Average
$1.6k
Median
$222
High
$15.7k
Each hospital's average Anthem rate, under the methodology and billing class chosen below.
213 hospitals; the 90th percentile is 63.1× 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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340 hospital rates
iThe hospitals that file a Anthem 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 | AKRON GENERAL MEDICAL CENTER Akron, OH facility · fee schedule · outpatient | 3 | $296 | $254 | $99 | 39% | — | $118 – $349 |
| 2 | Acadia Hospital Bangor, ME facility · fee schedule · outpatient | 2 | $114 | $114 | $14 | 12% | — | $99 – $128 |
| 3 | Acadia Hospital Bangor, ME professional · fee schedule · outpatient | 2 | $98 | $100 | $2 | 2% | — | $98 – $103 |
| 4 | Adena Fayette Medical Center Washington Court House, OH facility · percent of total billed charges · inpatientfrom % of charges | 3 | $2.5k | $4.0k | $6.1k | 151% | — | $58 – $23.0k |
| 5 | Adena Fayette Medical Center Washington Court House, OH facility · percent of total billed charges · outpatientfrom % of charges | 4 | $1.8k | $3.6k | $5.6k | 158% | — | $34 – $23.2k |
| 6 | Adena Health System Chillicothe, OH facility · percent of total billed charges · inpatientfrom % of charges | 1 | $2.9k | $4.5k | $6.7k | 148% | — | $84 – $22.6k |
| 7 | Adena Health System Chillicothe, OH facility · percent of total billed charges · outpatientfrom % of charges | 5 | $2.5k | $3.9k | $5.9k | 150% | — | $60 – $22.6k |
| 8 | Alta Bates Summit Medical Center Oakland, CA facility · fee schedule · outpatient | 1 | $177 | $177 | — | — | — | $177 – $177 |
| 9 | Alta Bates Summit Medical Center-Summit Campus-Hawthorne Oakland, CA facility · fee schedule · outpatient | 1 | $177 | $177 | — | — | — | $177 – $177 |
| 10 | American Hospital Management Corporation Arcata, CA facility · percent of total billed charges · outpatientfrom % of charges | 2 | $179 | $179 | — | — | — | $179 – $179 |
| 11 | Ascension SE Wisconsin Hospital, Inc. Milwaukee, WI other · outpatient | 2 | $161 | $161 | $8 | 5% | — | $153 – $170 |
| 12 | Aspirus Divine Savior Hospital Portage, WI fee schedule · outpatient | 2 | $515 | $515 | $392 | 76% | — | $123 – $907 |
| 13 | Aspirus Rhinelander Hospital Rhinelander, WI fee schedule · outpatient | 2 | $515 | $515 | $392 | 76% | — | $123 – $907 |
| 14 | Aspirus St. Luke’s Hospital Duluth, MN fee schedule · outpatient | 2 | $193 | $193 | $64 | 33% | — | $129 – $258 |
| 15 | Aspirus Stevens Point Hospital Stevens Point, WI fee schedule · outpatient | 2 | $515 | $515 | $392 | 76% | — | $123 – $907 |
| 16 | Aspirus Wausau Hospital Wausau, WI fee schedule · outpatient | 2 | $517 | $517 | $393 | 76% | — | $124 – $911 |
| 17 | Aspirus Wisconsin Rapids Hospital Wisconsin Rapids, WI fee schedule · outpatient | 2 | $515 | $515 | $392 | 76% | — | $123 – $907 |
| 18 | Atrium Medical Center Middletown, OH fee schedule · outpatient | 3 | $271 | $273 | $84 | 31% | — | $172 – $377 |
| 19 | Aurora Medical Center Bay Area Marinette, WI percent of total billed charges · inpatientfrom % of charges | 1 | $378 | $378 | — | — | — | $378 – $378 |
| 20 | Aurora Medical Center Bay Area Marinette, WI percent of total billed charges · outpatientfrom % of charges | 3 | $324 | $337 | $26 | 8% | — | $313 – $373 |
| 21 | Aurora Medical Center Burlington Burlington, WI percent of total billed charges · inpatientfrom % of charges | 1 | $459 | $459 | — | — | — | $459 – $459 |
| 22 | Aurora Medical Center Burlington Burlington, WI percent of total billed charges · outpatientfrom % of charges | 3 | $351 | $378 | $58 | 15% | — | $324 – $459 |
| 23 | Aurora Medical Center Fond du Lac Fond Du Lac, WI percent of total billed charges · inpatientfrom % of charges | 1 | $459 | $459 | — | — | — | $459 – $459 |
| 24 | Aurora Medical Center Fond du Lac Fond Du Lac, WI percent of total billed charges · outpatientfrom % of charges | 3 | $351 | $378 | $58 | 15% | — | $324 – $459 |
| 25 | Aurora Medical Center Grafton Grafton, WI percent of total billed charges · inpatientfrom % of charges | 1 | $459 | $459 | — | — | — | $459 – $459 |
← Payers reporting HCPCS Q4195 · Snapshot 20261111T120946Z-9134e7f7