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  5. /Fee schedule
HCPCS Q4119

Matristem wound matrix

Reported by 22 hospitals in the network under the fee schedule methodology.

Filter by billing methodology

All methodologiesAggregated across all available billing methodologies for this code.Case rateCMS definition: a flat rate for a package of items and services triggered by a diagnosis, treatment, or condition for a designated length of time.Fee scheduleCMS definition: the payer-specific negotiated charge is based on a fee schedule — for example, a Medicare, Medicaid, commercial payer, or workers’ compensation fee schedule.Per diemCMS definition: the per day charge for providing hospital items and services.Percent of billed chargesCMS definition: the payer-specific negotiated charge is based on a percentage of the total billed charges for an item or service, which may vary depending on certain pre-determined criteria being met.OtherCMS definition: used when the standard charge methodology can’t be described by case rate, fee schedule, per diem, or percent of total billed charges.

Reflects negotiated fee schedule rates with commercial payers.

National pricing summary

Low

$4

Average

$19

Median

$15

High

$34

Hospitals reporting this code

#HospitalLocationApproximate number of payer billing records behind this hospital’s price. CMS privacy rules cap small counts as a range (e.g. “1–10”) rather than an exact number — more samples means a more reliable price.
1The Mount Sinai HospitalNew York, NY$4$4——$4$4
2Alegent Creighton HealthOmaha, NE$30$33$15—$10$55
3Alegent Creighton HealthPapillion, NE$30$33$15—$12$55
4Alegent Health Bergan Mercy Health SystemOmaha, NE$21$32$15—$11$55
5Alegent Health Immanuel Medical CenterOmaha, NE$32$33$15—$9$55
6Alegent Health Bergan Mercy Health SystemCouncil Bluffs, IA$34$34$15—$10$55
7Alegent Health Bergan Mercy Health SystemOmaha, NE$30$33$15—$11$55
8MaineHealthPortland, ME$15$15——$15$15
9MaineHealthBiddeford, ME$15$15——$15$15
10Memorial Hospital of Laramie CountyCheyenne, WY$4$4——$4$4
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