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
$242
Median
$86
High
$3.6k
Each hospital's average Medicaid rate, under the methodology and billing class chosen below.
23 hospitals; the 90th percentile is 234.6× 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.
Filter by billing methodology
Filter by billing class
24 hospital rates
iThe hospitals that file a Medicaid 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 | Bullhead City Hospital Corporation City, AZ facility · percent of total billed charges · outpatientfrom % of charges | 1 | $161 | $161 | — | — | — | $161 – $161 |
| 2 | CATHOLIC HEALTH INITIATIVES COLORADO Salt Lake City, UT fee schedule · outpatient | 1 | $127 | $127 | — | — | — | $127 – $127 |
| 3 | CentraState Medical Center Freehold Township, NJ percent of total billed charges · bothfrom % of charges | 1 | $3.6k | $3.6k | — | — | — | $3.6k – $3.6k |
| 4 | Geisinger Community Medical Center Scranton, PA fee schedule · outpatient | 1 | $1 | $1 | — | — | — | $1 – $1 |
| 5 | Geisinger Lewistown Hospital Lewistown, PA fee schedule · outpatient | 1 | $1 | $1 | — | — | — | $1 – $1 |
| 6 | Geisinger Medical Center Muncy, PA fee schedule · outpatient | 1 | $1 | $1 | — | — | — | $1 – $1 |
| 7 | Geisinger Wyoming Valley Wilkes-Barre, PA fee schedule · outpatient | 1 | $1 | $1 | — | — | — | $1 – $1 |
| 8 | HANFORD COMMUNITY HOSPITAL Selma, CA fee schedule · outpatient | 1 | $143 | $143 | — | — | — | $143 – $143 |
| 9 | Hemet Global Medical Center Hemet, CA facility · fee schedule · outpatient | 1 | $71 | $71 | — | — | — | $71 – $71 |
| 10 | Hospital Authority of Colquitt County Moultrie, GA fee schedule · both | 1 | $333 | $333 | $10 | 3% | — | $323 – $343 |
| 11 | LODI MEMORIAL HOSPITAL ASSOCIATION INC Lodi, CA fee schedule · outpatient | 1 | $143 | $143 | — | — | — | $143 – $143 |
| 12 | Laredo Texas Hospital Company LP Laredo, TX facility · fee schedule · outpatient | 1 | $19 | $19 | — | — | — | $19 – $19 |
| 13 | Longview Medical Center LP Longview, TX facility · fee schedule · outpatient | 1 | $51 | $51 | — | — | — | $51 – $51 |
| 14 | Mercy Health Services-Iowa Corp. Mason City, IA professional · fee schedule · inpatient | 1 | $91 | $91 | — | — | — | $91 – $91 |
| 15 | Mercy Health Services-Iowa Corp. Mason City, IA professional · fee schedule · outpatient | 1 | $104 | $104 | — | — | — | $104 – $104 |
| 16 | Northwest Hospital LLC Tucson, AZ facility · percent of total billed charges · outpatientfrom % of charges | 1 | $86 | $86 | — | — | — | $86 – $86 |
| 17 | Ohio State University Hospitals Columbus, OH fee schedule · outpatient | 1 | $1 | $1 | — | — | — | $1 – $1 |
| 18 | Oro Valley Hospital LLC Tucson, AZ facility · percent of total billed charges · outpatientfrom % of charges | 1 | $86 | $86 | — | — | — | $86 – $86 |
| 19 | Piney Woods Healthcare System LP Lufkin, TX facility · fee schedule · outpatient | 1 | $253 | $253 | — | — | — | $253 – $253 |
| 20 | REEDLEY COMMUNITY HOSPITAL Reedley, CA fee schedule · outpatient | 1 | $143 | $143 | — | — | — | $143 – $143 |
| 21 | SONORA COMMUNITY HOSPITAL Sonora, CA fee schedule · outpatient | 1 | $143 | $143 | — | — | — | $143 – $143 |
| 22 | UKIAH ADVENTIST HOSPITAL Ukiah, CA fee schedule · outpatient | 1 | $71 | $71 | — | — | — | $71 – $71 |
| 23 | Victoria of Texas LP Victoria, TX facility · fee schedule · outpatient | 1 | $30 | $30 | — | — | — | $30 – $30 |
| 24 | Victoria of Texas LP Victoria, TX facility · fee schedule · outpatient | 1 | $30 | $30 | — | — | — | $30 – $30 |
← Payers reporting HCPCS Q4195 · Snapshot 20261111T120946Z-9134e7f7