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
$61
Average
$4.0k
Median
$127
High
$24.7k
Each hospital's average Tricare rate, under the methodology and billing class chosen below.
85 hospitals; the 90th percentile is 143.4× 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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90 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 | Affinity Hospital LLC Birmingham, AL facility · fee schedule · outpatient | 1 | $127 | $127 | — | — | — | $127 – $127 |
| 2 | Armstrong County Memorial Hospital Kittanning, PA facility · fee schedule · outpatient | 1 | $127 | $127 | — | — | — | $127 – $127 |
| 3 | Aspen Valley Hospital District Aspen, CO facility · percent of total billed charges · bothfrom % of charges | 4 | $6.6k | $8.0k | $2.4k | 30% | — | $6.6k – $12.1k |
| 4 | CLAIBORNE MEDICAL CENTER Tazewell, TN fee schedule · outpatient | 1 | $121 | $121 | — | — | — | $121 – $121 |
| 5 | CUMBERLAND MEDICAL CENTER, INC. Crossville, TN fee schedule · both | 1 | $121 | $121 | — | — | — | $121 – $121 |
| 6 | Campbell County HMA, LLC LaFollette, TN facility · fee schedule · outpatient | 1 | $127 | $127 | — | — | — | $127 – $127 |
| 7 | Canton-Potsdam Hospital Potsdam, NY facility · fee schedule · outpatient | 1 | $109 | $109 | — | — | — | $109 – $109 |
| 8 | CentraState Medical Center Freehold Township, NJ other · outpatient | 2 | $20.2k | $20.2k | — | — | — | $20.2k – $20.2k |
| 9 | Central Maine Medical Center Lewiston, ME fee schedule · outpatient | 1 | $127 | $127 | — | — | — | $127 – $127 |
| 10 | Charleston Area Medical Center Charleston, WV percent of total billed charges · bothfrom % of charges | 1 | $15.7k | $16.1k | $10.7k | 67% | — | $3.6k – $46.0k |
| 11 | Chilton Medical Center Pompton Plains, NJ other · outpatient | 2 | $20.2k | $20.2k | — | — | — | $20.2k – $20.2k |
| 12 | Cocke County HMA, LLC Newport, TN facility · fee schedule · outpatient | 1 | $127 | $127 | — | — | — | $127 – $127 |
| 13 | Conway Regional Medical Center Conway, AR facility · fee schedule · outpatient | 1 | $3.2k | $7.0k | $5.5k | 79% | — | $3.0k – $14.8k |
| 14 | Doylestown Hospital Doylestown, PA facility · fee schedule · outpatient | 1 | $127 | $127 | — | — | — | $127 – $127 |
| 15 | Ellis Hospital NY 12308; 2210 Troy Schenectady Road Niskayuna, NY facility · fee schedule · outpatient | 1 | $127 | $234 | $662 | 282% | — | $127 – $4.3k |
| 16 | FORT LOUDOUN MEDICAL CENTER Lenoir City, TN fee schedule · both | 1 | $113 | $113 | — | — | — | $113 – $113 |
| 17 | FORT SANDERS REGIONAL MEDICAL CENTER Knoxville, TN fee schedule · both | 1 | $113 | $113 | — | — | — | $113 – $113 |
| 18 | Fisher-Titus Medical Center Norwalk, OH facility · percent of total billed charges · inpatientfrom % of charges | 1 | $3.2k | $3.2k | $2.6k | 80% | — | $650 – $5.8k |
| 19 | Fisher-Titus Medical Center Norwalk, OH facility · percent of total billed charges · outpatientfrom % of charges | 1 | $3.0k | $3.0k | $2.4k | 80% | — | $610 – $5.5k |
| 20 | GUTHRIE CORTLAND MEDICAL CENTER Cortland, NY facility · other · outpatient | 1 | $206 | $206 | — | — | — | $206 – $206 |
| 21 | Garfield County, a political subdivision of the State of Utah, DBA Intermountain Health Garfield Memorial Hospital Panguitch, UT facility · percent of total billed charges · inpatientfrom % of charges | 1 | $106 | $106 | — | — | — | $106 – $106 |
| 22 | Garfield County, a political subdivision of the State of Utah, DBA Intermountain Health Garfield Memorial Hospital Panguitch, UT facility · percent of total billed charges · outpatientfrom % of charges | 1 | $89 | $89 | — | — | — | $89 – $89 |
| 23 | Hackettstown Medical Center Hackettstown, NJ other · outpatient | 2 | $20.2k | $20.2k | — | — | — | $20.2k – $20.2k |
| 24 | Hemet Global Medical Center Hemet, CA facility · fee schedule · outpatient | 1 | $127 | $1.1k | $2.3k | 215% | — | $127 – $6.6k |
| 25 | Hemet Global Medical Center Hemet, CA professional · fee schedule · outpatient | 1 | $119 | $119 | — | — | — | $119 – $119 |
← Payers reporting HCPCS Q4116 · Snapshot 20261111T120946Z-9134e7f7