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
TISSUE DERMAL MEMODERM (50SQ CM)5X10CM NON-MESHED EXTRA THICK 19800
Low
$1
Average
$1.0k
Median
$56
High
$11.2k
Each hospital's average Medicaid rate, under the methodology and billing class chosen below.
17 hospitals; the 90th percentile is 135.5× 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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17 hospital rates
iThe hospitals that file a Medicaid 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 | ADVENTIST HEALTH TULARE Tulare, CA fee schedule · outpatient | 1 | $88 | $88 | — | — | — | $88 – $88 |
| 2 | CATHOLIC HEALTH INITIATIVES COLORADO Salt Lake City, UT fee schedule · outpatient | 1 | $127 | $127 | — | — | — | $127 – $127 |
| 3 | CentraState Medical Center Freehold Township, NJ percent of total billed charges · bothfrom % of charges | 1 | $4.2k | $5.2k | $3.7k | 70% | — | $1.4k – $10.2k |
| 4 | Chapman Global Medical Center Orange, CA facility · fee schedule · outpatient | 1 | $60 | $60 | — | — | — | $60 – $60 |
| 5 | FRANCISCAN ALLIANCE, INC. dba FRANCISCAN HEALTH CARMEL CARMEL, IN fee schedule · both | 2 | $56 | $56 | $5 | 9% | — | $51 – $61 |
| 6 | FRANCISCAN ALLIANCE, INC. dba FRANCISCAN HEALTH INDIANAPOLIS INDIANAPOLIS, IN fee schedule · both | 16 | $51 | $53 | $4 | 8% | — | $51 – $61 |
| 7 | FRANCISCAN ALLIANCE, INC. dba FRANCISCAN HEALTH MOORESVILLE MOORESVILLE, IN fee schedule · both | 2 | $56 | $56 | $5 | 9% | — | $51 – $61 |
| 8 | FRANCISCAN ALLIANCE, INC. dba FRANCISCAN HEALTH MUNSTER MUNSTER, IN fee schedule · both | 2 | $56 | $56 | $5 | 9% | — | $51 – $61 |
| 9 | Granbury Hospital Corporation Granbury, TX facility · fee schedule · outpatient | 1 | $39 | $39 | — | — | — | $39 – $39 |
| 10 | Hemet Global Medical Center Hemet, CA facility · fee schedule · outpatient | 1 | $60 | $60 | — | — | — | $60 – $60 |
| 11 | Hospital Authority of Colquitt County Moultrie, GA fee schedule · both | 1 | $8.6k | $11.2k | $8.8k | 79% | — | $291 – $26.2k |
| 12 | Laredo Texas Hospital Company LP Laredo, TX facility · fee schedule · outpatient | 1 | $46 | $46 | — | — | — | $46 – $46 |
| 13 | Northwest Hospital LLC Tucson, AZ facility · percent of total billed charges · outpatientfrom % of charges | 1 | $22 | $22 | $2 | 9% | — | $20 – $24 |
| 14 | Ohio State University Hospitals Columbus, OH fee schedule · outpatient | 1 | $1 | $1 | — | — | — | $1 – $1 |
| 15 | Oro Valley Hospital LLC Tucson, AZ facility · percent of total billed charges · outpatientfrom % of charges | 1 | $22 | $22 | $2 | 9% | — | $20 – $24 |
| 16 | Victoria of Texas LP Victoria, TX facility · fee schedule · outpatient | 1 | $16 | $16 | — | — | — | $16 – $16 |
| 17 | Victoria of Texas LP Victoria, TX facility · fee schedule · outpatient | 1 | $16 | $16 | — | — | — | $16 – $16 |
← Payers reporting HCPCS Q4126 · Snapshot 20261111T120946Z-9134e7f7