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
BARRIER ADHES 3X5IN PROC PK BIORESORB MEMBRANE SEPRAFILM SOD HYALURONATE
Low
$134
Average
$1.5k
Median
$1.2k
High
$5.1k
Each hospital's average Tricare rate, under the methodology and billing class chosen below.
49 hospitals; the 90th percentile is 12.2× 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.
Filter by billing methodology
Filter by billing class
50 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 | Anderson Hospital Maryville, IL facility · fee schedule · outpatient | 1 | $335 | $335 | — | — | — | $335 – $335 |
| 2 | Armstrong County Memorial Hospital Kittanning, PA facility · fee schedule · outpatient | 1 | $1.4k | $1.4k | — | — | — | $1.4k – $1.4k |
| 3 | Beaufort Memorial Hospital Beaufort, SC facility · percent of total billed charges · inpatientfrom % of charges | 1 | $866 | $866 | — | — | — | $866 – $866 |
| 4 | CORNING HOSPITAL Corning, NY facility · other · outpatient | 1 | $980 | $980 | — | — | — | $980 – $980 |
| 5 | CentraState Medical Center Freehold Township, NJ fee schedule · outpatient | 2 | $1.0k | $1.0k | $53 | 5% | — | $955 – $1.1k |
| 6 | Charleston Area Medical Center Charleston, WV percent of total billed charges · bothfrom % of charges | 1 | $4.7k | $5.1k | $3.1k | 60% | — | $1.7k – $9.9k |
| 7 | Chilton Medical Center Pompton Plains, NJ fee schedule · outpatient | 2 | $1.0k | $1.0k | $21 | 2% | — | $1.0k – $1.0k |
| 8 | Conway Regional Medical Center Conway, AR facility · fee schedule · outpatient | 1 | $428 | $428 | — | — | — | $428 – $428 |
| 9 | Doylestown Hospital Doylestown, PA facility · fee schedule · outpatient | 1 | $840 | $840 | — | — | — | $840 – $840 |
| 10 | Dukes Health System LLC Peru, IN facility · fee schedule · outpatient | 1 | $636 | $636 | — | — | — | $636 – $636 |
| 11 | Ellis Hospital NY 12308; 2210 Troy Schenectady Road Niskayuna, NY facility · fee schedule · outpatient | 1 | $1.2k | $1.2k | $311 | 25% | — | $870 – $1.6k |
| 12 | HSA PGH LLC Hialeah, FL facility · percent of total billed charges · outpatientfrom % of charges | 1 | $1.6k | $1.6k | — | — | — | $1.6k – $1.6k |
| 13 | Hackettstown Medical Center Hackettstown, NJ fee schedule · outpatient | 2 | $1.0k | $1.0k | $21 | 2% | — | $1.0k – $1.0k |
| 14 | Holy Cross Germantown Hospital Germantown, MD facility · percent of total billed charges · bothfrom % of charges | 1 | $1.0k | $1.7k | $1.6k | 95% | — | $663 – $6.0k |
| 15 | Holy Cross Hospital-Silver Spring Silver Spring, MD facility · percent of total billed charges · bothfrom % of charges | 1 | $780 | $1.5k | $1.6k | 107% | — | $552 – $5.9k |
| 16 | KAPLAN GENERAL HOSPITAL, INC ST, LA percent of total billed charges · outpatientfrom % of charges | 1 | $1.1k | $1.3k | $477 | 38% | — | $899 – $2.4k |
| 17 | MCLAREN CARO REGION CARO, MI fee schedule | 1 | $3.2k | $3.2k | — | — | — | $3.2k – $3.2k |
| 18 | MCLAREN THUMB REGION AXE, MI fee schedule | 1 | $2.0k | $2.0k | — | — | — | $2.0k – $2.0k |
| 19 | McLeod Health Cheraw, SC percent of total billed charges · bothfrom % of charges | 1 | $2.6k | $4.1k | $3.4k | 82% | — | $1.4k – $9.7k |
| 20 | MedStar Franklin Square Medical Center Baltimore, MD percent of total billed charges · outpatientfrom % of charges | 1 | $1.4k | $1.4k | $570 | 40% | — | $456 – $2.2k |
| 21 | MedStar Good Samaritan Hospital Baltimore, MD percent of total billed charges · outpatientfrom % of charges | 1 | $1.8k | $1.9k | $465 | 25% | — | $1.3k – $2.6k |
| 22 | MedStar Harbor Hospital Baltimore, MD percent of total billed charges · outpatientfrom % of charges | 1 | $1.2k | $1.3k | $305 | 23% | — | $1.0k – $1.9k |
| 23 | MedStar Montgomery Medical Center Olney, MD percent of total billed charges · outpatientfrom % of charges | 1 | $1.3k | $1.3k | $473 | 36% | — | $597 – $2.0k |
| 24 | MedStar Southern Hospital Center Clinton, MD percent of total billed charges · outpatientfrom % of charges | 1 | $1.8k | $1.8k | $630 | 35% | — | $855 – $2.8k |
| 25 | MedStar St. Mary's Hospital Leonardtown, MD percent of total billed charges · outpatientfrom % of charges | 1 | $1.9k | $1.7k | $766 | 44% | — | $480 – $2.8k |
← Payers reporting HCPCS C1765 · Snapshot 20261111T120946Z-9134e7f7