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
$1
Average
$355
Median
$161
High
$4.8k
Each hospital's average Caresource rate, under the methodology and billing class chosen below.
125 hospitals; the 90th percentile is 2.8× 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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131 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 Fayette Medical Center Washington Court House, OH facility · percent of total billed charges · outpatientfrom % of charges | 1 | $1.9k | $3.0k | $4.4k | 148% | — | $55 – $14.8k |
| 3 | Adena Health System Chillicothe, OH facility · fee schedule · outpatient | 2 | $179 | $179 | $58 | 32% | — | $121 – $238 |
| 4 | Beavercreek Medical Center Springfield, OH fee schedule · outpatient | 1 | $190 | $190 | — | — | — | $190 – $190 |
| 5 | Berger Hospital Circleville, OH fee schedule · outpatient | 1 | $175 | $175 | — | — | — | $175 – $175 |
| 6 | CHI MEMORIAL HOSPITAL - GEORGIA Ringgold, GA fee schedule · outpatient | 1 | $67 | $67 | — | — | — | $67 – $67 |
| 7 | Camden-Clark Memorial Hospital Corporation Parkersburg, WV facility · other · outpatient | 2 | $161 | $161 | $28 | 18% | — | $133 – $190 |
| 8 | Catawba Valley Medical Center Hickory, NC fee schedule · outpatient | 1 | $270 | $270 | — | — | — | $270 – $270 |
| 9 | Charleston Area Medical Center Charleston, WV percent of total billed charges · bothfrom % of charges | 1 | $2.3k | $2.6k | $1.8k | 69% | — | $293 – $5.8k |
| 10 | City Hospital, Inc. Martinsburg, WV facility · other · outpatient | 1 | $190 | $190 | — | — | — | $190 – $190 |
| 11 | Clinton Memorial Hospital Wilmington, OH fee schedule · outpatient | 1 | $156 | $156 | — | — | — | $156 – $156 |
| 12 | Columbus Regional Hospital Columbus, IN fee schedule · both | 2 | $49 | $49 | — | — | — | $49 – $49 |
| 13 | Dayton Osteopathic Hospital Dayton, OH fee schedule · outpatient | 1 | $190 | $190 | — | — | — | $190 – $190 |
| 14 | Deaconess Health System Gibson General Hospital Princeton, IN professional · fee schedule · both | 2 | $103 | $95 | $35 | 37% | — | $49 – $134 |
| 15 | Deaconess Health System Henderson Hospital Henderson, KY professional · fee schedule · both | 2 | $91 | $91 | $42 | 46% | — | $49 – $134 |
| 16 | Deaconess Health System Union County Hospital Morganfield, KY professional · fee schedule · both | 2 | $91 | $91 | $42 | 46% | — | $49 – $134 |
| 17 | Deaconess Hospital, Inc Newburgh, IN professional · fee schedule · both | 2 | $91 | $91 | $42 | 46% | — | $49 – $134 |
| 18 | Deaconess Hospital, Inc Newburgh, IN facility · case rate · outpatient | 1 | $49 | $49 | — | — | — | $49 – $49 |
| 19 | Deaconess Hospital, Inc Newburgh, IN professional · fee schedule · both | 3 | $76 | $84 | $36 | 43% | — | $49 – $134 |
| 20 | Doctors Hospital Columbus, OH fee schedule · outpatient | 1 | $175 | $175 | — | — | — | $175 – $175 |
| 21 | Dublin Methodist Hospital Dublin, OH fee schedule · outpatient | 1 | $175 | $175 | — | — | — | $175 – $175 |
| 22 | FAIRVIEW PARK HOSPITAL DUBLIN, GA fee schedule · outpatient | 1 | $130 | $130 | — | — | — | $130 – $130 |
| 23 | Fairfield Medical Center 401 N Ewing St facility · fee schedule · outpatient | 3 | $122 | $126 | $23 | 19% | — | $99 – $156 |
| 24 | Fort Hamilton Hospital Hamilton, OH fee schedule · outpatient | 1 | $191 | $191 | — | — | — | $191 – $191 |
| 25 | GRMC, Inc. Oakland, MD percent of total billed charges · bothfrom % of charges | 1 | $184 | $184 | $22 | 12% | — | $161 – $206 |
← Payers reporting HCPCS Q4195 · Snapshot 20261111T120946Z-9134e7f7