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
$26
Average
$1.9k
Median
$194
High
$28.7k
Each hospital's average Wellmark rate, under the methodology and billing class chosen below.
55 hospitals; the 90th percentile is 73.6× 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.
Filter by billing methodology
Filter by billing class
66 hospital rates
iThe hospitals that file a Wellmark 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 | Avera McKennan Hospital Sioux Falls, SD case rate · outpatient | 2 | $28.7k | $28.7k | — | — | 98 | $28.7k – $28.7k |
| 2 | ALEGENT HEALTH - MERCY HOSPITAL, CORNING IOWA Corning, IA fee schedule · inpatient | 2 | $4.4k | $5.4k | $5.1k | 96% | — | $174 – $26.1k |
| 3 | ALEGENT HEALTH - MERCY HOSPITAL, CORNING IOWA Corning, IA fee schedule · outpatient | 2 | $3.7k | $4.5k | $4.3k | 96% | — | $145 – $21.7k |
| 4 | ALEGENT HEALTH BERGAN MERCY HEALTH SYSTEM Council Bluffs, IA fee schedule · outpatient | 2 | $1.8k | $2.5k | $2.5k | 101% | — | $39 – $12.6k |
| 5 | ALEGENT HEALTH COMMUNITY MEMORIAL HOSPITAL OF MISSOURI VALLEY, IOWA Missouri Valley, IA fee schedule · inpatient | 2 | $4.2k | $5.1k | $4.9k | 96% | — | $165 – $24.8k |
| 6 | ALEGENT HEALTH COMMUNITY MEMORIAL HOSPITAL OF MISSOURI VALLEY, IOWA Missouri Valley, IA fee schedule · outpatient | 2 | $3.7k | $4.5k | $4.3k | 96% | — | $145 – $21.7k |
| 7 | Central Community Hospital Elkader, IA facility · percent of total billed charges · bothfrom % of charges | 1 | $47 | $165 | $647 | 391% | — | $0 – $3.9k |
| 8 | Diley Ridge Medical Center Canal Winchester, OH facility · percent of total billed charges · bothfrom % of charges | 1 | $65 | $194 | $710 | 367% | — | $1 – $4.3k |
| 9 | Holy Cross Germantown Hospital Germantown, MD facility · percent of total billed charges · bothfrom % of charges | 1 | $86 | $319 | $1.3k | 401% | — | $1 – $7.8k |
| 10 | Holy Cross Hospital-Ft. Lauderdale Ft. Lauderdale, FL facility · per diem · both | 1 | $763 | $763 | — | — | — | $763 – $763 |
| 11 | 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 |
| 12 | Johnson Memorial Hospital Stafford Springs, CT facility · percent of total billed charges · bothfrom % of charges | 1 | $54 | $268 | $1.2k | 447% | — | $1 – $7.3k |
| 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 | Mercy Hospital of Franciscan Sisters Inc Oelwein, IA facility · percent of total billed charges · bothfrom % of charges | 1 | $37 | $130 | $510 | 391% | — | $0 – $3.1k |
| 19 | Mercy Medical Center - Dyersville Dyersville, IA facility · percent of total billed charges · bothfrom % of charges | 1 | $51 | $178 | $697 | 391% | — | $0 – $4.2k |
| 20 | Mercy Medical Center - New Hampton New Hampton, IA facility · percent of total billed charges · bothfrom % of charges | 1 | $43 | $129 | $472 | 367% | — | $1 – $2.9k |
| 21 | MercyOne Genesis Aledo Medical Center Aledo, IL facility · case rate · both | 1 | $34.1k | $29.3k | $14.5k | 50% | — | $1.3k – $51.8k |
| 22 | MercyOne Genesis Aledo Medical Center Aledo, IL facility · percent of total billed charges · inpatientfrom % of charges | 1 | $19.8k | $17.0k | $8.4k | 50% | — | $740 – $30.0k |
| 23 | MercyOne Genesis Aledo Medical Center Aledo, IL facility · percent of total billed charges · outpatientfrom % of charges | 1 | $16.0k | $13.8k | $6.8k | 50% | — | $599 – $24.3k |
| 24 | MercyOne Genesis DeWitt Medical Center DeWitt, IA facility · percent of total billed charges · bothfrom % of charges | 1 | $17.0k | $14.6k | $7.3k | 50% | — | $638 – $25.9k |
| 25 | MercyOne Genesis DeWitt Medical Center DeWitt, IA facility · percent of total billed charges · inpatientfrom % of charges | 1 | $14.6k | $12.6k | $6.2k | 50% | — | $548 – $22.3k |
← Payers reporting HCPCS Q4116 · Snapshot 20261111T120946Z-9134e7f7