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
Xwrap 1 sq cm
Low
$1
Average
$17.2k
Median
$13.1k
High
$36.6k
Each hospital's average MultiPlan rate, under the methodology and billing class chosen below.
20 hospitals; the 90th percentile is 20.4× 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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27 hospital rates
iThe hospitals that file a MultiPlan 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 | Centennial Hills Las Vegas, NV percent of total billed charges · bothfrom % of charges | 1 | $33.9k | $29.8k | $6.5k | 22% | — | $19.1k – $36.2k |
| 2 | Champlain Valley Physicians Hospital Medical Center Plattsburgh, NY facility · percent of total billed charges · outpatientfrom % of charges | 1 | $6.2k | $6.2k | $282 | 5% | — | $5.9k – $6.5k |
| 3 | DIGNITY COMMUNITY CARE Chandler, AZ fee schedule · inpatient | 1 | $20.1k | $20.1k | $2.6k | 13% | — | $17.5k – $22.7k |
| 4 | DIGNITY COMMUNITY CARE Chandler, AZ fee schedule · outpatient | 1 | $20.1k | $20.1k | $2.6k | 13% | — | $17.5k – $22.7k |
| 5 | DIGNITY COMMUNITY CARE Los Angeles, CA fee schedule · inpatient | 1 | $18.1k | $36.6k | $29.1k | 80% | — | $13.9k – $77.6k |
| 6 | DIGNITY COMMUNITY CARE Los Angeles, CA fee schedule · outpatient | 1 | $18.1k | $36.6k | $29.1k | 80% | — | $13.9k – $77.6k |
| 7 | DIGNITY HEALTH Henderson, NV fee schedule · inpatient | 1 | $11.5k | $11.5k | $1.5k | 13% | — | $10.0k – $13.0k |
| 8 | DIGNITY HEALTH Henderson, NV fee schedule · outpatient | 1 | $11.5k | $11.5k | $1.5k | 13% | — | $10.0k – $13.0k |
| 9 | DIGNITY HEALTH Phoenix, AZ fee schedule · inpatient | 1 | $7.1k | $14.0k | $13.4k | 95% | — | $4.7k – $37.0k |
| 10 | DIGNITY HEALTH Phoenix, AZ fee schedule · outpatient | 1 | $7.1k | $14.0k | $13.4k | 95% | — | $4.7k – $37.0k |
| 11 | DIGNITY HEALTH Gilbert, AZ fee schedule · inpatient | 1 | $18.4k | $18.4k | $2.4k | 13% | — | $16.0k – $20.8k |
| 12 | DIGNITY HEALTH Gilbert, AZ fee schedule · outpatient | 1 | $18.4k | $18.4k | $2.4k | 13% | — | $16.0k – $20.8k |
| 13 | DIGNITY HEALTH Las Vegas, NV fee schedule · inpatient | 1 | $11.5k | $11.5k | $1.5k | 13% | — | $10.0k – $13.0k |
| 14 | DIGNITY HEALTH Las Vegas, NV fee schedule · outpatient | 1 | $11.5k | $11.5k | $1.5k | 13% | — | $10.0k – $13.0k |
| 15 | Fort Duncan Medical Center LP Eagle Pass, TX percent of total billed charges · bothfrom % of charges | 1 | $12.1k | $12.1k | — | — | — | $12.1k – $12.1k |
| 16 | HCA FLORIDA NORTH FLORIDA HOSPITAL GAINESVILLE, FL percent of total billed charges · outpatientfrom % of charges | 2 | $1 | $1 | $0 | 5% | — | $1 – $1 |
| 17 | Henderson Hospital Henderson, NV percent of total billed charges · bothfrom % of charges | 1 | $33.9k | $29.8k | $6.5k | 22% | — | $19.1k – $36.2k |
| 18 | MaineHealth Belfast, ME percent of total billed charges · inpatientfrom % of charges | 1 | $1.6k | $1.6k | — | — | — | $1.6k – $1.6k |
| 19 | MaineHealth Belfast, ME percent of total billed charges · outpatientfrom % of charges | 1 | $1.6k | $1.6k | — | — | — | $1.6k – $1.6k |
| 20 | Northwest Texas Healthcare System Amarillo, TX percent of total billed charges · bothfrom % of charges | 1 | $11.2k | $11.2k | $1.1k | 10% | — | $10.1k – $12.2k |
| 21 | Northwest Texas Healthcare System, Inc. Amarillo, TX percent of total billed charges · bothfrom % of charges | 1 | $11.2k | $11.2k | $1.1k | 10% | — | $10.1k – $12.2k |
| 22 | Northwest Texas Healthcare System, Inc. Amarillo, TX percent of total billed charges · bothfrom % of charges | 1 | $11.2k | $11.2k | $1.1k | 10% | — | $10.1k – $12.2k |
| 23 | Spring Valley Hospital Medical Center Las Vegas, NV percent of total billed charges · bothfrom % of charges | 1 | $33.9k | $29.8k | $6.5k | 22% | — | $19.1k – $36.2k |
| 24 | Summerlin Hospital Medical Center Las Vegas, NV percent of total billed charges · bothfrom % of charges | 1 | $33.9k | $29.8k | $6.5k | 22% | — | $19.1k – $36.2k |
| 25 | Valley County Hospital NE 68862-1240; 400 S 23rd St Ord, NE professional · fee schedule · both | 1 | $379 | $379 | — | — | — | $379 – $379 |
← Payers reporting HCPCS Q4204 · Snapshot 20261112T181611Z-3fa9fb76