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
HC Implant Graft Purified Collagen Matrix Phmb Antimicrobial Extra Fenestrated Puraply 25cm 515-071 Puraplyam Xt-Com4.91x4.91ef
Low
$61
Average
$883
Median
$127
High
$6.9k
Each hospital's average Tricare rate, under the methodology and billing class chosen below.
31 hospitals; the 90th percentile is 18.8× 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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31 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 | CORNING HOSPITAL Corning, NY facility · other · outpatient | 1 | $291 | $291 | — | — | — | $291 – $291 |
| 3 | CUMBERLAND MEDICAL CENTER, INC. Crossville, TN fee schedule · outpatient | 1 | $121 | $121 | — | — | — | $121 – $121 |
| 4 | Canton-Potsdam Hospital Potsdam, NY facility · fee schedule · outpatient | 1 | $109 | $109 | — | — | — | $109 – $109 |
| 5 | CentraState Medical Center Freehold Township, NJ other · outpatient | 2 | $2.1k | $2.1k | — | — | — | $2.1k – $2.1k |
| 6 | Chilton Medical Center Pompton Plains, NJ other · outpatient | 2 | $2.1k | $2.1k | — | — | — | $2.1k – $2.1k |
| 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 | GUTHRIE CORTLAND MEDICAL CENTER Cortland, NY facility · other · outpatient | 1 | $291 | $291 | — | — | — | $291 – $291 |
| 11 | Hackettstown Medical Center Hackettstown, NJ other · outpatient | 2 | $2.1k | $2.1k | — | — | — | $2.1k – $2.1k |
| 12 | Hospital Authority of Colquitt County Moultrie, GA fee schedule · both | 1 | $333 | $333 | $10 | 3% | — | $323 – $343 |
| 13 | Kaleida Health Buffalo, NY fee schedule · outpatient | 1 | $148 | $148 | — | — | — | $148 – $148 |
| 14 | LECONTE MEDICAL CENTER Sevierville, TN fee schedule · outpatient | 1 | $121 | $121 | — | — | — | $121 – $121 |
| 15 | MCLAREN CARO REGION CARO, MI fee schedule | 1 | $6.9k | $6.9k | — | — | — | $6.9k – $6.9k |
| 16 | MCLAREN THUMB REGION AXE, MI fee schedule | 1 | $4.4k | $4.4k | — | — | — | $4.4k – $4.4k |
| 17 | METHODIST MEDICAL CENTER OF OAK RIDGE Oak Ridge, TN fee schedule · outpatient | 1 | $113 | $113 | — | — | — | $113 – $113 |
| 18 | MORRISTOWN HAMBLEN HOSPITAL ASSOCIATION Morristown, TN fee schedule · outpatient | 1 | $113 | $113 | — | — | — | $113 – $113 |
| 19 | Mercy Hospital Cassville Knob, MO facility · percent of total billed charges · outpatientfrom % of charges | 1 | $61 | $61 | — | — | — | $61 – $61 |
| 20 | Mid Hudson Regional Hospital Poughkeepsie, NY facility · fee schedule · outpatient | 1 | $127 | $127 | — | — | — | $127 – $127 |
| 21 | Morristown Medical Center Morristown, NJ other · outpatient | 2 | $2.1k | $2.1k | — | — | — | $2.1k – $2.1k |
| 22 | Newark-Wayne Community Hospital Newark, NY facility · fee schedule · outpatient | 1 | $121 | $121 | — | — | — | $121 – $121 |
| 23 | Newton Medical Center Newton, NJ other · outpatient | 2 | $2.1k | $2.1k | — | — | — | $2.1k – $2.1k |
| 24 | Overlook Medical Center Summit, NJ other · outpatient | 2 | $2.1k | $2.1k | — | — | — | $2.1k – $2.1k |
| 25 | PARKWEST MEDICAL CENTER Knoxville, TN fee schedule · outpatient | 1 | $113 | $113 | — | — | — | $113 – $113 |
← Payers reporting HCPCS Q4197 · Snapshot 20261111T120946Z-9134e7f7