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
GRAFT SOFT TISSUE 16X10CM TUTOPATCH BOVINE PERICARDIUM STERILE LATEX FREE
Low
$0
Average
$3.0k
Median
$1.9k
High
$21.6k
Each hospital's average Blue Cross Blue Shield rate, under the methodology and billing class chosen below.
434 hospitals; the 90th percentile is 270.6× 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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550 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 | Virtua_Our_Lady_of_Lourdes_Inc Camden, NJ percent of total billed charges · outpatientfrom % of charges | 1 | $3.1k | $3.1k | — | — | 90–900 | $3.1k – $3.1k |
| 2 | Children's Healthcare of Atlanta Atlanta, GA percent of total billed charges · outpatientfrom % of charges | 2 | $3.7k | $4.8k | $3.7k | 78% | 27–270 | $1.1k – $20.4k |
| 3 | Children's Healthcare of Atlanta Atlanta, GA percent of total billed charges · outpatientfrom % of charges | 2 | $3.8k | $4.9k | $3.7k | 76% | 26–260 | $1.2k – $20.4k |
| 4 | Mayo Clinic Rochester, MN facility · percent of total billed charges · bothfrom % of charges | 10 | $1.8k | $3.7k | $5.9k | 160% | 20–92 | $59 – $22.6k |
| 5 | Mayo Clinic Florida Jacksonville, FL facility · percent of total billed charges · bothfrom % of charges | 5 | $855 | $2.2k | $3.6k | 159% | 11–110 | $223 – $15.2k |
| 6 | Samaritan Hospital Troy, NY facility · percent of total billed charges · bothfrom % of charges | 1 | $1.7k | $2.2k | $2.0k | 91% | 4–40 | $63 – $5.4k |
| 7 | St Peters Hospital Albany, NY facility · percent of total billed charges · bothfrom % of charges | 1 | $2.4k | $2.6k | $2.2k | 83% | 3–30 | $63 – $5.4k |
| 8 | Forsyth Memorial Hospital, Inc. Winston-Salem, NC percent of total billed charges · outpatientfrom % of charges | 2 | $1.5k | $1.5k | — | — | 2–20 | $1.5k – $1.5k |
| 9 | West Virginia University Hospitals, Inc. Morgantown, WV facility · percent of total billed charges · outpatientfrom % of charges | 1 | $678 | $678 | — | — | 2–20 | $678 – $678 |
| 10 | Northfield Hospital Northfield, MN other · both | 1 | $0 | $0 | — | — | 1–10 | $0 – $0 |
| 11 | ADVENTIST HEALTH MEDICAL CENTER TEHACHAPI Tehachapi, CA case rate · outpatient | 2 | $1.2k | $1.2k | $61 | 5% | — | $1.1k – $1.2k |
| 12 | ADVENTIST HEALTH MEDICAL CENTER TEHACHAPI Tehachapi, CA percent of total billed charges · outpatientfrom % of charges | 3 | $6.8k | $6.8k | $2.8k | 42% | — | $2.8k – $11.1k |
| 13 | ADVENTIST HEALTH TULARE Tulare, CA percent of total billed charges · outpatientfrom % of charges | 3 | $2.9k | $3.5k | $2.0k | 58% | — | $2.1k – $7.6k |
| 14 | AGH LAVEEN LLC Phoenix, AZ fee schedule · outpatient | 3 | $513 | $570 | $81 | 14% | — | $513 – $684 |
| 15 | AGH MESA LLC Mesa, AZ fee schedule · outpatient | 3 | $513 | $570 | $81 | 14% | — | $513 – $684 |
| 16 | ALBANY MEDICAL CENTER HOSPITAL Albany, NY facility · case rate · outpatient | 4 | $1.7k | $2.2k | $810 | 37% | — | $1.4k – $3.2k |
| 17 | ALBANY MEDICAL CENTER HOSPITAL Albany, NY facility · percent of total billed charges · bothfrom % of charges | 3 | $2.6k | $3.5k | $3.1k | 87% | — | $143 – $11.8k |
| 18 | ALBANY MEDICAL CENTER HOSPITAL Albany, NY facility · percent of total billed charges · inpatientfrom % of charges | 3 | $2.6k | $3.4k | $3.0k | 87% | — | $143 – $11.4k |
| 19 | ALBANY MEDICAL CENTER HOSPITAL Albany, NY facility · percent of total billed charges · outpatientfrom % of charges | 3 | $2.6k | $3.4k | $3.0k | 87% | — | $143 – $11.4k |
| 20 | ALEGENT CREIGHTON HEALTH Plainview, NE fee schedule · inpatient | 2 | $4.7k | $4.9k | $2.4k | 49% | — | $2.0k – $8.2k |
| 21 | ALEGENT CREIGHTON HEALTH Plainview, NE fee schedule · outpatient | 3 | $4.6k | $4.4k | $2.3k | 53% | — | $1.4k – $8.2k |
| 22 | ALEGENT HEALTH - MERCY HOSPITAL, CORNING IOWA Corning, IA fee schedule · outpatient | 1 | $1.6k | $1.7k | $1.4k | 81% | — | $0 – $3.7k |
| 23 | ALEGENT HEALTH COMMUNITY MEMORIAL HOSPITAL OF MISSOURI VALLEY, IOWA Missouri Valley, IA fee schedule · inpatient | 2 | $3.3k | $3.7k | $3.0k | 81% | — | $0 – $8.2k |
| 24 | ALEGENT HEALTH COMMUNITY MEMORIAL HOSPITAL OF MISSOURI VALLEY, IOWA Missouri Valley, IA fee schedule · outpatient | 2 | $3.3k | $3.7k | $3.0k | 81% | — | $0 – $8.2k |
| 25 | ALEGENT HEALTH MEMORIAL HOSPITAL, SCHUYLER Schuyler, NE fee schedule · inpatient | 2 | $3.3k | $3.7k | $3.0k | 81% | — | $0 – $8.2k |
← Payers reporting HCPCS Q4100 · Snapshot 20261111T120946Z-9134e7f7