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
Axolotl graf dualgraf sq cm
Low
$1
Average
$1.7k
Median
$1.4k
High
$7.1k
Each hospital's average Blue Cross Blue Shield rate, under the methodology and billing class chosen below.
45 hospitals; the 90th percentile is 385.0× 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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46 hospital rates
iThe hospitals that file a Blue Cross Blue Shield 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 | ALBANY MEDICAL CENTER HOSPITAL Albany, NY facility · case rate · outpatient | 4 | $1.7k | $2.2k | $810 | 37% | — | $1.4k – $3.2k |
| 2 | Barnesville Hospital Association, Inc. Barnesville, OH facility · case rate · outpatient | 1 | $4.7k | $4.7k | — | — | — | $4.7k – $4.7k |
| 3 | Beaufort Memorial Hospital Beaufort, SC facility · fee schedule · outpatient | 1 | $848 | $848 | — | — | — | $848 – $848 |
| 4 | Benson Hospital Corporation Benson, AZ facility · fee schedule · outpatient | 1 | $7.1k | $7.1k | — | — | — | $7.1k – $7.1k |
| 5 | COLUMBIA MEMORIAL HOSPITAL Hudson, NY facility · case rate · outpatient | 3 | $2.6k | $2.2k | $566 | 26% | — | $1.4k – $2.6k |
| 6 | Covenant Medical Center Lubbock, TX fee schedule · outpatient | 4 | $12 | $12 | $0 | 2% | — | $12 – $12 |
| 7 | East Alabama Medical Center OPELIKA, AL facility · fee schedule · outpatient | 1 | $750 | $750 | — | — | — | $750 – $750 |
| 8 | East Alabama Medical Center OPELIKA, AL professional · fee schedule · outpatient | 1 | $750 | $750 | — | — | — | $750 – $750 |
| 9 | Essentia Health St. Joseph's Medical Center Brainerd, MN facility · fee schedule · outpatient | 1 | $1 | $1 | — | — | — | $1 – $1 |
| 10 | Essentia Health St. Mary's - Detroit Lakes 1027 Washington Ave. Detroit Lakes, MN facility · fee schedule · outpatient | 2 | $1 | $1 | — | — | — | $1 – $1 |
| 11 | Essentia Health St. Mary's Children's Hospital Duluth, MN facility · fee schedule · outpatient | 1 | $1 | $1 | — | — | — | $1 – $1 |
| 12 | Essentia Health St. Mary's Medical Center Duluth, MN facility · fee schedule · outpatient | 1 | $1 | $1 | — | — | — | $1 – $1 |
| 13 | Fairview Maple Grove Surgery Center Maple Grove, MN fee schedule · outpatient | 3 | $887 | $776 | $169 | 22% | — | $538 – $903 |
| 14 | GLENS FALLS HOSPITAL INC Falls, NY facility · case rate · outpatient | 1 | $1.4k | $1.4k | — | — | — | $1.4k – $1.4k |
| 15 | Keck Hospital of USC Los Angeles, CA facility · fee schedule · outpatient | 2 | $2.5k | $2.5k | $46 | 2% | — | $2.4k – $2.5k |
| 16 | Lubbock Heritage Hospital LLC Lubbock, TX fee schedule · outpatient | 4 | $12 | $12 | $0 | 2% | — | $12 – $12 |
| 17 | Methodist Children's Hospital Lubbock, TX fee schedule · outpatient | 4 | $12 | $12 | $0 | 2% | — | $12 – $12 |
| 18 | Methodist Hospital Levelland Levelland, TX fee schedule · outpatient | 4 | $11 | $11 | $0 | 2% | — | $11 – $12 |
| 19 | Methodist Hospital Plainview Plainview, TX fee schedule · outpatient | 4 | $11 | $11 | $0 | 2% | — | $11 – $12 |
| 20 | Mission Hospital Regional Med Center Laguna Beach, CA fee schedule · outpatient | 2 | $1.4k | $1.4k | — | — | — | $1.4k – $1.4k |
| 21 | NorCal HealthConnect LLC Petaluma, CA fee schedule · outpatient | 3 | $1.3k | $1.2k | $99 | 8% | — | $1.1k – $1.3k |
| 22 | NorCal HealthConnect LLC Healdsburg, CA fee schedule · outpatient | 1 | $2.7k | $2.7k | — | — | — | $2.7k – $2.7k |
| 23 | Phoenix Children's Hospital Phoenix, AZ facility · fee schedule · outpatient | 1 | $5.1k | $5.1k | — | — | — | $5.1k – $5.1k |
| 24 | Providence Health System - Southern California Santa Monica, CA fee schedule · outpatient | 1 | $2.3k | $2.3k | — | — | — | $2.3k – $2.3k |
| 25 | Providence Health System - Southern California Burbank, CA fee schedule · outpatient | 1 | $3.0k | $3.0k | — | — | — | $3.0k – $3.0k |
← Payers reporting HCPCS Q4210 · Snapshot 20261112T181611Z-3fa9fb76