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
Xcm biologic tissue matrix, per square centimeter (add-on, list separately in addition to primary procedure)
Low
$1
Average
$223
Median
$179
High
$1.2k
Each hospital's average Caresource rate, under the methodology and billing class chosen below.
59 hospitals; the 90th percentile is 15.4× 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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70 hospital rates
iThe hospitals that file a Caresource 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 | Adena Fayette Medical Center Washington Court House, OH facility · case rate · outpatient | 1 | $254 | $254 | — | — | — | $254 – $254 |
| 2 | Adena Health System Chillicothe, OH facility · fee schedule · outpatient | 2 | $179 | $179 | $58 | 32% | — | $121 – $238 |
| 3 | Clinton Memorial Hospital Wilmington, OH fee schedule · outpatient | 1 | $156 | $156 | — | — | — | $156 – $156 |
| 4 | Deaconess Hospital, Inc Newburgh, IN facility · case rate · outpatient | 1 | $49 | $49 | — | — | — | $49 – $49 |
| 5 | Diley Ridge Medical Center Canal Winchester, OH facility · percent of total billed charges · bothfrom % of charges | 1 | $65 | $65 | — | — | — | $65 – $65 |
| 6 | Greenfield Area Medical Center Greenfield, OH facility · case rate · outpatient | 1 | $254 | $254 | — | — | — | $254 – $254 |
| 7 | Indiana University Health Arnett Inc. Lafayette, IN fee schedule · outpatient | 3 | $524 | $408 | $192 | 47% | — | $51 – $524 |
| 8 | Indiana University Health Ball Memorial Hospital Inc. Muncie, IN fee schedule · outpatient | 3 | $524 | $408 | $192 | 47% | — | $51 – $524 |
| 9 | Indiana University Health Bedford Inc. Bedford, IN fee schedule · outpatient | 2 | $524 | $429 | $189 | 44% | — | $51 – $524 |
| 10 | Indiana University Health Bloomington Inc. Bloomington, IN fee schedule · outpatient | 3 | $524 | $408 | $192 | 47% | — | $51 – $524 |
| 11 | Indiana University Health Frankfort Inc. Frankfort, IN fee schedule · outpatient | 2 | $524 | $429 | $189 | 44% | — | $51 – $524 |
| 12 | Indiana University Health Inc. Martinsville, IN fee schedule · outpatient | 3 | $524 | $408 | $192 | 47% | — | $51 – $524 |
| 13 | Indiana University Health Jay Inc. Portland, IN fee schedule · outpatient | 2 | $524 | $429 | $189 | 44% | — | $51 – $524 |
| 14 | Indiana University Health North Hospital Inc. Carmel, IN fee schedule · outpatient | 3 | $524 | $408 | $192 | 47% | — | $51 – $524 |
| 15 | Indiana University Health Paoli Inc. Paoli, IN fee schedule · outpatient | 2 | $524 | $429 | $189 | 44% | — | $51 – $524 |
| 16 | Indiana University Health Tipton Hospital Inc. Tipton, IN fee schedule · outpatient | 2 | $524 | $429 | $189 | 44% | — | $51 – $524 |
| 17 | Indiana University Health West Hospital Inc. Avon, IN fee schedule · outpatient | 3 | $524 | $408 | $192 | 47% | — | $51 – $524 |
| 18 | Indiana University Health White Memorial Hospital Inc. Monticello, IN fee schedule · outpatient | 2 | $524 | $429 | $189 | 44% | — | $51 – $524 |
| 19 | Mercy Health Hackley Campus Muskogen, MI facility · percent of total billed charges · bothfrom % of charges | 1 | $42 | $42 | — | — | — | $42 – $42 |
| 20 | Mercy Health Lakeshore Campus Shelby, MI facility · percent of total billed charges · bothfrom % of charges | 1 | $60 | $60 | — | — | — | $60 – $60 |
| 21 | Mercy Health Saint Marys Rockford, MI facility · percent of total billed charges · bothfrom % of charges | 1 | $59 | $59 | — | — | — | $59 – $59 |
| 22 | Mount Carmel East Reynoldsburg, OH facility · percent of total billed charges · bothfrom % of charges | 1 | $65 | $65 | — | — | — | $65 – $65 |
| 23 | Mount Carmel Grove City Grove City, OH facility · percent of total billed charges · bothfrom % of charges | 1 | $65 | $65 | — | — | — | $65 – $65 |
| 24 | Mount Carmel New Albany Surgical Hospital New Albany, OH facility · percent of total billed charges · bothfrom % of charges | 1 | $65 | $65 | — | — | — | $65 – $65 |
| 25 | Mount Carmel St Ann's Lewis Center, OH facility · percent of total billed charges · bothfrom % of charges | 1 | $65 | $65 | — | — | — | $65 – $65 |
← Payers reporting HCPCS Q4142 · Snapshot 20261111T120946Z-9134e7f7