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
MEMBRANE PLACENTA TISS BIODFENCE G3 4X4CM-16SQCM-Q4116-COST PER SQ CM
Low
$0
Average
$1.1k
Median
$172
High
$15.6k
Each hospital's average Aetna rate, under the methodology and billing class chosen below.
583 hospitals; the 90th percentile is 30.6× 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.
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644 hospital rates
iThe hospitals that file a Aetna 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 | ACADIA GENERAL HOSPITAL, INC 1305 CROWLEY RAYNE HWY other · inpatient | 1 | $7.3k | $8.9k | $4.5k | 50% | — | $5.2k – $17.3k |
| 2 | ACADIA GENERAL HOSPITAL, INC 1305 CROWLEY RAYNE HWY other · outpatient | 1 | $7.3k | $8.9k | $4.5k | 50% | — | $5.2k – $17.3k |
| 3 | AKRON GENERAL MEDICAL CENTER Akron, OH facility · fee schedule · outpatient | 3 | $288 | $266 | $113 | 43% | — | $118 – $392 |
| 4 | ARTHUR G JAMES CANCER HOSPITAL AND RESEARCH INSTITUTE Columbus, OH per diem · inpatient | 1 | $5.4k | $5.4k | — | — | — | $5.4k – $5.4k |
| 5 | Abington Memorial Hospital Abington, PA facility · fee schedule · outpatient | 1 | $359 | $359 | — | — | — | $359 – $359 |
| 6 | Acadia Hospital Bangor, ME professional · fee schedule · outpatient | 2 | $222 | $222 | $61 | 27% | — | $162 – $283 |
| 7 | Adena Fayette Medical Center Washington Court House, OH facility · fee schedule · outpatient | 1 | $1.1k | $1.1k | — | — | — | $1.1k – $1.1k |
| 8 | Adena Health System Chillicothe, OH facility · fee schedule · outpatient | 2 | $601 | $601 | $482 | 80% | — | $119 – $1.1k |
| 9 | AdventHealth Avista Louisville, CO fee schedule · outpatient | 1 | $133 | $133 | — | — | — | $133 – $133 |
| 10 | AdventHealth Castle Rock Castle Rock, CO fee schedule · outpatient | 1 | $131 | $131 | — | — | — | $131 – $131 |
| 11 | AdventHealth Littleton Littleton, CO fee schedule · outpatient | 1 | $131 | $131 | — | — | — | $131 – $131 |
| 12 | AdventHealth Parker Aurora, CO fee schedule · outpatient | 1 | $131 | $131 | — | — | — | $131 – $131 |
| 13 | AdventHealth Porter Denver, CO fee schedule · outpatient | 1 | $131 | $131 | — | — | — | $131 – $131 |
| 14 | Allen Memorial Hospital Corporation Waterloo, IA fee schedule · both | 2 | $50 | $50 | $1 | 1% | — | $50 – $51 |
| 15 | Alomere Health Alexandria, MN facility · fee schedule · outpatient | 1 | $128 | $128 | — | — | — | $128 – $128 |
| 16 | Alta Newport Hospital, LLC Tustin, CA facility · case rate · outpatient | 2 | $406 | $406 | $0 | 0% | — | $406 – $406 |
| 17 | Altru Hospital Devils Lake Devils Lake, ND facility · fee schedule · outpatient | 2 | $134 | $163 | $47 | 29% | — | $127 – $229 |
| 18 | Aspirus Divine Savior Hospital Portage, WI fee schedule · outpatient | 1 | $121 | $121 | — | — | — | $121 – $121 |
| 19 | Aspirus Rhinelander Hospital Rhinelander, WI fee schedule · outpatient | 1 | $121 | $121 | — | — | — | $121 – $121 |
| 20 | Aspirus St. Luke’s Hospital Duluth, MN fee schedule · outpatient | 1 | $133 | $133 | — | — | — | $133 – $133 |
| 21 | Aspirus Stevens Point Hospital Stevens Point, WI fee schedule · outpatient | 1 | $121 | $121 | — | — | — | $121 – $121 |
| 22 | Aspirus Wausau Hospital Wausau, WI fee schedule · outpatient | 1 | $121 | $121 | — | — | — | $121 – $121 |
| 23 | Aspirus Wisconsin Rapids Hospital Wisconsin Rapids, WI fee schedule · outpatient | 1 | $121 | $121 | — | — | — | $121 – $121 |
| 24 | Aurora BayCare Medical Center Green Bay, WI fee schedule · outpatient | 1 | $177 | $177 | — | — | — | $177 – $177 |
| 25 | Aurora Lakeland Medical Center Elkhorn, WI fee schedule · outpatient | 1 | $177 | $177 | — | — | — | $177 – $177 |
← Payers reporting HCPCS Q4140 · Snapshot 20261111T120946Z-9134e7f7