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
$318
Average
$1.2k
Median
$845
High
$7.6k
Each hospital's average UnitedHealthcare rate, under the methodology and billing class chosen below.
38 hospitals; the 90th percentile is 5.3× 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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38 hospital rates
iThe hospitals that file a UnitedHealthcare 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 | Adventhealth Redmond Rome, GA fee schedule · outpatient | 1 | $831 | $831 | — | — | — | $831 – $831 |
| 2 | Barnesville Hospital Association, Inc. Barnesville, OH facility · fee schedule · outpatient | 1 | $490 | $490 | — | — | — | $490 – $490 |
| 3 | Braxton County Memorial Hospital Gassaway, WV facility · fee schedule · outpatient | 1 | $490 | $490 | — | — | — | $490 – $490 |
| 4 | Cass Regional Medical Center Harrisonville, MO facility · fee schedule · outpatient | 1 | $2.3k | $2.3k | — | — | — | $2.3k – $2.3k |
| 5 | City Hospital, Inc. Martinsburg, WV facility · fee schedule · outpatient | 1 | $490 | $490 | — | — | — | $490 – $490 |
| 6 | Community Health Association Ripley, WV facility · fee schedule · outpatient | 1 | $490 | $490 | — | — | — | $490 – $490 |
| 7 | Covenant Medical Center Lubbock, TX fee schedule · outpatient | 1 | $3.2k | $3.2k | — | — | — | $3.2k – $3.2k |
| 8 | Denver Health and Hospital Authority Denver, CO facility · fee schedule · outpatient | 1 | $1.4k | $1.4k | — | — | — | $1.4k – $1.4k |
| 9 | GRITMAN MEDICAL CENTER INC Moscow, ID professional · fee schedule · outpatient | 1 | $848 | $848 | — | — | — | $848 – $848 |
| 10 | Grant Memorial Hospital Inc Petersburg, WV facility · fee schedule · outpatient | 1 | $490 | $490 | — | — | — | $490 – $490 |
| 11 | HCA Healthcare Live Oak Mental Health and Wellness Ladson, SC fee schedule · outpatient | 1 | $1.0k | $1.0k | — | — | — | $1.0k – $1.0k |
| 12 | HCA Healthcare Summerville Hospital SUMMERVILLE, SC fee schedule · outpatient | 1 | $1.0k | $1.0k | — | — | — | $1.0k – $1.0k |
| 13 | HCA Healthcare Trident Hospital SUMMERVILLE, SC fee schedule · outpatient | 1 | $1.0k | $1.0k | — | — | — | $1.0k – $1.0k |
| 14 | Harrison Community Hospital, Inc. Cadiz, OH facility · fee schedule · outpatient | 1 | $490 | $490 | — | — | — | $490 – $490 |
| 15 | Herbert J Thomas Memorial Hospital Association South Charleston, WV facility · fee schedule · outpatient | 1 | $490 | $490 | — | — | — | $490 – $490 |
| 16 | Jefferson Medical Center Ranson, WV facility · fee schedule · outpatient | 1 | $490 | $490 | — | — | — | $490 – $490 |
| 17 | Kirby Medical Center Monticello, IL professional · fee schedule · both | 1 | $848 | $848 | — | — | — | $848 – $848 |
| 18 | Lubbock Heritage Hospital LLC Lubbock, TX fee schedule · outpatient | 1 | $3.2k | $3.2k | — | — | — | $3.2k – $3.2k |
| 19 | MUSC Medical Center Charleston, SC facility · fee schedule · outpatient | 1 | $1.8k | $1.8k | — | — | — | $1.8k – $1.8k |
| 20 | MaineHealth North Conway, NH fee schedule · both | 1 | $995 | $995 | — | — | — | $995 – $995 |
| 21 | MaineHealth Belfast, ME fee schedule · both | 1 | $995 | $995 | — | — | — | $995 – $995 |
| 22 | MaineHealth Farmington, ME fee schedule · both | 1 | $995 | $995 | — | — | — | $995 – $995 |
| 23 | MaineHealth Portland, ME fee schedule · both | 1 | $1.4k | $1.4k | — | — | — | $1.4k – $1.4k |
| 24 | MaineHealth Norway, ME fee schedule · both | 1 | $995 | $995 | — | — | — | $995 – $995 |
| 25 | Memorial Hospital of Laramie County Cheyenne, WY fee schedule · both | 1 | $824 | $824 | — | — | — | $824 – $824 |
← Payers reporting HCPCS Q4210 · Snapshot 20261112T181611Z-3fa9fb76