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
$5
Average
$5.5k
Median
$5.2k
High
$29.8k
Each hospital's average Tricare rate, under the methodology and billing class chosen below.
32 hospitals; the 90th percentile is 85.8× 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
36 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 | CentraState Medical Center Freehold Township, NJ other · outpatient | 2 | $8.3k | $8.3k | — | — | — | $8.3k – $8.3k |
| 2 | Charleston Area Medical Center Charleston, WV percent of total billed charges · bothfrom % of charges | 1 | $4.3k | $7.5k | $8.2k | 110% | — | $232 – $29.2k |
| 3 | Chilton Medical Center Pompton Plains, NJ other · outpatient | 2 | $8.3k | $8.3k | — | — | — | $8.3k – $8.3k |
| 4 | Conway Regional Medical Center Conway, AR facility · fee schedule · outpatient | 1 | $7.8k | $9.0k | $6.1k | 67% | — | $1.1k – $19.9k |
| 5 | Ellis Hospital NY 12308; 2210 Troy Schenectady Road Niskayuna, NY facility · fee schedule · outpatient | 1 | $132 | $2.8k | $5.4k | 193% | — | $11 – $14.7k |
| 6 | Fisher-Titus Medical Center Norwalk, OH facility · percent of total billed charges · inpatientfrom % of charges | 1 | $2.0k | $2.0k | — | — | — | $2.0k – $2.0k |
| 7 | Fisher-Titus Medical Center Norwalk, OH facility · percent of total billed charges · outpatientfrom % of charges | 1 | $1.9k | $1.9k | — | — | — | $1.9k – $1.9k |
| 8 | HOULTON REGIONAL HOSPITAL HOULTON, ME percent of total billed charges · bothfrom % of charges | 1 | $2.6k | $2.6k | — | — | — | $2.6k – $2.6k |
| 9 | HSA PGH LLC Hialeah, FL facility · percent of total billed charges · outpatientfrom % of charges | 1 | $9.1k | $9.1k | $2.0k | 22% | — | $7.2k – $11.1k |
| 10 | Hackettstown Medical Center Hackettstown, NJ other · outpatient | 2 | $8.3k | $8.3k | — | — | — | $8.3k – $8.3k |
| 11 | Hemet Global Medical Center Hemet, CA facility · fee schedule · outpatient | 1 | $6.0k | $6.6k | $3.3k | 50% | — | $2.6k – $11.8k |
| 12 | Hemet Global Medical Center Hemet, CA professional · fee schedule · outpatient | 1 | $3.9k | $4.3k | $2.2k | 50% | — | $1.7k – $7.7k |
| 13 | Holy Cross Germantown Hospital Germantown, MD facility · percent of total billed charges · bothfrom % of charges | 1 | $2.8k | $3.1k | $2.5k | 82% | — | $109 – $6.2k |
| 14 | Holy Cross Hospital-Silver Spring Silver Spring, MD facility · percent of total billed charges · bothfrom % of charges | 1 | $2.7k | $3.0k | $2.5k | 83% | — | $80 – $6.1k |
| 15 | KAPLAN GENERAL HOSPITAL, INC ST, LA percent of total billed charges · outpatientfrom % of charges | 1 | $4.4k | $4.9k | $2.8k | 57% | — | $360 – $10.8k |
| 16 | MCLAREN CARO REGION CARO, MI fee schedule | 1 | $6.1k | $6.1k | — | — | — | $6.1k – $6.1k |
| 17 | MCLAREN THUMB REGION AXE, MI fee schedule | 1 | $3.9k | $3.9k | — | — | — | $3.9k – $3.9k |
| 18 | McLeod Health Cheraw, SC percent of total billed charges · bothfrom % of charges | 1 | $6.9k | $8.3k | $7.8k | 94% | — | $199 – $27.6k |
| 19 | Morristown Medical Center Morristown, NJ other · outpatient | 2 | $8.3k | $8.3k | — | — | — | $8.3k – $8.3k |
| 20 | Newton Medical Center Newton, NJ other · outpatient | 2 | $8.3k | $8.3k | — | — | — | $8.3k – $8.3k |
| 21 | Northside Hospital, Inc. Lawrenceville, GA fee schedule · outpatient | 1 | $102 | $105 | $31 | 30% | — | $68 – $144 |
| 22 | Northside Hospital, Inc. Atlanta, GA fee schedule · outpatient | 1 | $102 | $105 | $31 | 30% | — | $68 – $144 |
| 23 | Northside Hospital, Inc. Cumming, GA fee schedule · outpatient | 1 | $102 | $105 | $31 | 30% | — | $68 – $144 |
| 24 | Northside Hospital, Inc. Duluth, GA fee schedule · outpatient | 1 | $102 | $105 | $31 | 30% | — | $68 – $144 |
| 25 | Northside Hospital, Inc. Canton, GA fee schedule · outpatient | 1 | $102 | $105 | $31 | 30% | — | $68 – $144 |
← Payers reporting HCPCS Q4100 · Snapshot 20261111T120946Z-9134e7f7