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
MATRIX TISSUE 20X16CM ALLODERM SELECT THK.4-2.4MM THICK
Low
$71
Average
$725
Median
$252
High
$8.0k
Each hospital's average Excellus rate, under the methodology and billing class chosen below.
47 hospitals; the 90th percentile is 9.5× 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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48 hospital rates
iThe hospitals that file a Excellus 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 | Champlain Valley Physicians Hospital Medical Center Plattsburgh, NY facility · percent of total billed charges · outpatientfrom % of charges | 2 | $3.9k | $5.7k | $5.3k | 93% | — | $120 – $19.8k |
| 2 | Clifton Springs Hospital And Clinic Clifton Springs, NY facility · fee schedule · outpatient | 1 | $104 | $104 | — | — | — | $104 – $104 |
| 3 | Diley Ridge Medical Center Canal Winchester, OH facility · percent of total billed charges · bothfrom % of charges | 1 | $65 | $194 | $710 | 367% | — | $1 – $4.3k |
| 4 | F.F. Thompson Hospital Canandaigua, NY fee schedule · outpatient | 2 | $289 | $289 | $62 | 21% | — | $227 – $351 |
| 5 | Highland Hospital Rochester, NY fee schedule · outpatient | 7 | $539 | $1.5k | $3.1k | 203% | — | $71 – $21.4k |
| 6 | Holy Cross Germantown Hospital Germantown, MD facility · percent of total billed charges · bothfrom % of charges | 1 | $86 | $319 | $1.3k | 401% | — | $1 – $7.8k |
| 7 | Holy Cross Hospital-Ft. Lauderdale Ft. Lauderdale, FL facility · per diem · both | 1 | $763 | $763 | — | — | — | $763 – $763 |
| 8 | Holy Cross Hospital-Silver Spring Silver Spring, MD facility · percent of total billed charges · bothfrom % of charges | 1 | $64 | $282 | $1.2k | 439% | — | $1 – $7.6k |
| 9 | Johnson Memorial Hospital Stafford Springs, CT facility · percent of total billed charges · bothfrom % of charges | 1 | $54 | $268 | $1.2k | 447% | — | $1 – $7.3k |
| 10 | MVHS, Inc. Utica, NY percent of total billed charges · bothfrom % of charges | 3 | $156 | $168 | $100 | 59% | — | $63 – $401 |
| 11 | Margaretville Memorial Hospital Margaretville, NY facility · fee schedule · outpatient | 2 | $8.1k | $8.0k | $3.7k | 46% | — | $2.2k – $13.3k |
| 12 | Memorial Hosp of Wm F & Gertrude F Jones A/K/A Jones Memorial Hosp Wellsville, NY fee schedule · outpatient | 2 | $127 | $127 | — | — | — | $127 – $127 |
| 13 | Mercy Fitzgerald Hospital Darby, PA facility · percent of total billed charges · bothfrom % of charges | 1 | $149 | $738 | $3.3k | 447% | — | $3 – $20.0k |
| 14 | Mercy Health Hackley Campus Muskogen, MI facility · fee schedule · outpatient | 1 | $14.4k | $14.4k | — | — | — | $14.4k – $14.4k |
| 15 | Mercy Health Hackley Campus Muskogen, MI facility · percent of total billed charges · bothfrom % of charges | 1 | $40 | $133 | $517 | 389% | — | $1 – $3.2k |
| 16 | Mercy Health Lakeshore Campus Shelby, MI facility · percent of total billed charges · bothfrom % of charges | 1 | $70 | $238 | $919 | 387% | — | $1 – $5.6k |
| 17 | Mercy Health Saint Marys Rockford, MI facility · percent of total billed charges · bothfrom % of charges | 1 | $52 | $132 | $430 | 326% | — | $1 – $2.6k |
| 18 | Mishawaka Medical Center Mishawaka, IN facility · percent of total billed charges · bothfrom % of charges | 1 | $39 | $194 | $868 | 447% | — | $1 – $5.3k |
| 19 | Mount Carmel East Reynoldsburg, OH facility · percent of total billed charges · bothfrom % of charges | 1 | $65 | $320 | $1.4k | 447% | — | $1 – $8.7k |
| 20 | Mount Carmel Grove City Grove City, OH facility · percent of total billed charges · bothfrom % of charges | 1 | $65 | $320 | $1.4k | 447% | — | $1 – $8.7k |
| 21 | Mount Carmel New Albany Surgical Hospital New Albany, OH facility · percent of total billed charges · bothfrom % of charges | 1 | $65 | $320 | $1.4k | 447% | — | $1 – $8.7k |
| 22 | Mount Carmel St Ann's Lewis Center, OH facility · percent of total billed charges · bothfrom % of charges | 1 | $65 | $320 | $1.4k | 447% | — | $1 – $8.7k |
| 23 | Nazareth Hospital Philadelphia, PA facility · percent of total billed charges · bothfrom % of charges | 1 | $149 | $738 | $3.3k | 447% | — | $3 – $20.0k |
| 24 | Newark-Wayne Community Hospital Newark, NY facility · fee schedule · outpatient | 1 | $252 | $252 | — | — | — | $252 – $252 |
| 25 | Nicholas H. Noyes Memorial Hospital Dansville, NY fee schedule · outpatient | 2 | $220 | $220 | — | — | — | $220 – $220 |
← Payers reporting HCPCS Q4116 · Snapshot 20261111T120946Z-9134e7f7