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
Acelagraft, per square centimeter (add-on, list separately in addition to primary procedure)
Low
$116
Average
$134
Median
$133
High
$158
Each hospital's average WellCare rate, under the methodology and billing class chosen below.
62 hospitals; the 90th percentile is 1.3× 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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66 hospital rates
iThe hospitals that file a WellCare 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 | AMH Cath Labs LLC Arlington, TX case rate · outpatient | 2 | $135 | $135 | $3 | 2% | — | $131 – $138 |
| 2 | Canton-Potsdam Hospital Potsdam, NY facility · fee schedule · outpatient | 2 | $123 | $123 | — | — | — | $123 – $123 |
| 3 | Carle BroMenn Medical Center Normal, IL case rate · outpatient | 1 | $133 | $133 | — | — | — | $133 – $133 |
| 4 | Carle Eureka Hospital Eureka, IL case rate · outpatient | 1 | $133 | $133 | — | — | — | $133 – $133 |
| 5 | Cleveland Clinic Weston Hospital Nonprofit Corporation Weston, FL facility · fee schedule · outpatient | 1 | $130 | $130 | — | — | — | $130 – $130 |
| 6 | F.F. Thompson Hospital Canandaigua, NY fee schedule · outpatient | 1 | $127 | $127 | — | — | — | $127 – $127 |
| 7 | Good Samaritan Hospital Puyallup, WA fee schedule · outpatient | 1 | $149 | $149 | — | — | — | $149 – $149 |
| 8 | Harborview Medical Center Seattle, WA fee schedule · outpatient | 1 | $151 | $151 | — | — | — | $151 – $151 |
| 9 | INDIAN RIVER MEMORIAL HOSPITAL INC Vero Beach, FL facility · fee schedule · outpatient | 1 | $130 | $130 | — | — | — | $130 – $130 |
| 10 | Indiana University Health Arnett Inc. Lafayette, IN fee schedule · outpatient | 1 | $135 | $135 | — | — | — | $135 – $135 |
| 11 | Indiana University Health Ball Memorial Hospital Inc. Muncie, IN fee schedule · outpatient | 1 | $135 | $135 | — | — | — | $135 – $135 |
| 12 | Indiana University Health Bloomington Inc. Bloomington, IN fee schedule · outpatient | 1 | $135 | $135 | — | — | — | $135 – $135 |
| 13 | Indiana University Health Inc. Martinsville, IN fee schedule · outpatient | 1 | $135 | $135 | — | — | — | $135 – $135 |
| 14 | Indiana University Health North Hospital Inc. Carmel, IN fee schedule · outpatient | 1 | $135 | $135 | — | — | — | $135 – $135 |
| 15 | Indiana University Health West Hospital Inc. Avon, IN fee schedule · outpatient | 1 | $135 | $135 | — | — | — | $135 – $135 |
| 16 | Inspira Medical Center Mullica Hill Hill, NJ fee schedule · outpatient | 1 | $140 | $140 | — | — | — | $140 – $140 |
| 17 | Inspira Medical Center Vineland Vineland, NJ fee schedule · outpatient | 1 | $140 | $140 | — | — | — | $140 – $140 |
| 18 | Kirby Medical Center Monticello, IL professional · fee schedule · both | 1 | $116 | $116 | — | — | — | $116 – $116 |
| 19 | MARTIN MEMORIAL MEDICAL CENTER INC Port St Lucie, FL facility · fee schedule · outpatient | 1 | $130 | $130 | — | — | — | $130 – $130 |
| 20 | Mary Bridge Children's Hospital Tacoma, WA fee schedule · outpatient | 1 | $149 | $149 | — | — | — | $149 – $149 |
| 21 | Memorial Hosp of Wm F & Gertrude F Jones A/K/A Jones Memorial Hosp Wellsville, NY fee schedule · outpatient | 1 | $127 | $127 | — | — | — | $127 – $127 |
| 22 | Methodist Medical Center of Illinois Peoria, IL case rate · outpatient | 1 | $133 | $133 | — | — | — | $133 – $133 |
| 23 | Montefiore Medical Center Bronx, NY fee schedule · outpatient | 1 | $158 | $158 | — | — | — | $158 – $158 |
| 24 | Montefiore Mount Vernon Hospital Mount Vernon, NY fee schedule · outpatient | 1 | $158 | $158 | — | — | — | $158 – $158 |
| 25 | Montefiore New Rochelle Hospital New Rochelle, NY fee schedule · outpatient | 1 | $158 | $158 | — | — | — | $158 – $158 |
← Payers reporting HCPCS Q4395 · Snapshot 20261113T090226Z-3ce6c0b8