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
DRSG WND MESH BOVINE BILAYER 4X10IN MATRIX-Q4104-COST PER SQ CM
Low
$14
Average
$2.6k
Median
$146
High
$28.2k
Each hospital's average Optum rate, under the methodology and billing class chosen below.
124 hospitals; the 90th percentile is 75.6× 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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126 hospital rates
iThe hospitals that file a Optum 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 | Acadia Hospital Bangor, ME professional · fee schedule · outpatient | 1 | $52 | $52 | — | — | — | $52 – $52 |
| 2 | Affinity Hospital LLC Birmingham, AL facility · fee schedule · outpatient | 1 | $114 | $114 | — | — | — | $114 – $114 |
| 3 | Affinity Hospital LLC Birmingham, AL facility · percent of total billed charges · outpatientfrom % of charges | 1 | $71 | $71 | — | — | — | $71 – $71 |
| 4 | Baylor Scott & White Medical Center - Plano Plano, TX facility · percent of total billed charges · outpatientfrom % of charges | 1 | $127 | $153 | $114 | 75% | — | $44 – $375 |
| 5 | Baylor University Medical Center Dallas, TX facility · percent of total billed charges · outpatientfrom % of charges | 1 | $127 | $153 | $114 | 75% | — | $44 – $375 |
| 6 | Betsy Johnson Hospital Dunn, NC facility · other · outpatient | 1 | $127 | $127 | — | — | — | $127 – $127 |
| 7 | Bexar County Hospital District San Antonio, TX percent of total billed charges · outpatientfrom % of charges | 1 | $17.0k | $17.0k | — | — | — | $17.0k – $17.0k |
| 8 | Bluffton Health System LLC Bluffton, IN facility · per diem · outpatient | 1 | $132 | $132 | — | — | — | $132 – $132 |
| 9 | CATHOLIC HEALTH INIATIVES COLORADO Westminster, CO fee schedule · outpatient | 1 | $125 | $125 | — | — | — | $125 – $125 |
| 10 | CATHOLIC HEALTH INITIATIVES COLORADO Pueblo, CO fee schedule · outpatient | 1 | $125 | $125 | — | — | — | $125 – $125 |
| 11 | CATHOLIC HEALTH INITIATIVES COLORADO Colorado Springs, CO fee schedule · outpatient | 1 | $125 | $125 | — | — | — | $125 – $125 |
| 12 | CATHOLIC HEALTH INITIATIVES COLORADO Frisco, CO fee schedule · outpatient | 1 | $125 | $125 | — | — | — | $125 – $125 |
| 13 | CATHOLIC HEALTH INITIATIVES COLORADO Durango, CO fee schedule · outpatient | 1 | $125 | $125 | — | — | — | $125 – $125 |
| 14 | CATHOLIC HEALTH INITIATIVES COLORADO Lakewood, CO fee schedule · outpatient | 1 | $125 | $125 | — | — | — | $125 – $125 |
| 15 | CATHOLIC HEALTH INITIATIVES COLORADO Colorado Springs, CO fee schedule · outpatient | 1 | $125 | $125 | — | — | — | $125 – $125 |
| 16 | CLAIBORNE MEDICAL CENTER Tazewell, TN fee schedule · outpatient | 1 | $121 | $121 | — | — | — | $121 – $121 |
| 17 | CLEVELAND CLINIC AVON HOSPITAL Avon, OH facility · percent of total billed charges · outpatientfrom % of charges | 1 | $3.9k | $3.9k | — | — | — | $3.9k – $3.9k |
| 18 | CLEVELAND CLINIC HEALTH SYSTEM - EAST REGION Mentor, OH facility · percent of total billed charges · outpatientfrom % of charges | 1 | $3.9k | $3.9k | — | — | — | $3.9k – $3.9k |
| 19 | CLEVELAND CLINIC HEALTH SYSTEM - EAST REGION Euclid, OH facility · percent of total billed charges · outpatientfrom % of charges | 1 | $3.9k | $3.9k | — | — | — | $3.9k – $3.9k |
| 20 | CLEVELAND CLINIC HEALTH SYSTEM - EAST REGION Warrensville Heights, OH facility · percent of total billed charges · outpatientfrom % of charges | 1 | $3.9k | $3.9k | — | — | — | $3.9k – $3.9k |
| 21 | CUMBERLAND MEDICAL CENTER, INC. Crossville, TN fee schedule · outpatient | 1 | $121 | $121 | — | — | — | $121 – $121 |
| 22 | Campbell County HMA, LLC LaFollette, TN facility · fee schedule · outpatient | 1 | $121 | $121 | — | — | — | $121 – $121 |
| 23 | Chatham Hospital Siler City, NC facility · percent of total billed charges · outpatientfrom % of charges | 1 | $61 | $61 | — | — | — | $61 – $61 |
| 24 | Childrens Hospital of Los Angeles Angeles, CA facility · per diem · outpatient | 1 | $1.7k | $1.7k | — | — | — | $1.7k – $1.7k |
| 25 | Cocke County HMA, LLC Newport, TN facility · per diem · outpatient | 1 | $121 | $121 | — | — | — | $121 – $121 |
← Payers reporting HCPCS Q4104 · Snapshot 20261111T120946Z-9134e7f7