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
$0
Average
$346
Median
$125
High
$8.4k
Each hospital's average Molina rate, under the methodology and billing class chosen below.
151 hospitals; the 90th percentile is 11.1× 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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160 hospital rates
iThe hospitals that file a Molina 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 | AMH Cath Labs LLC Arlington, TX case rate · outpatient | 1 | $131 | $131 | — | — | — | $131 – $131 |
| 2 | ARH Mary Breckinridge Health Services, Inc Barbourville, KY percent of total billed charges · outpatientfrom % of charges | 1 | $100 | $112 | $75 | 68% | — | $14 – $240 |
| 3 | ARH Mary Breckinridge Health Services, Inc Hayden, KY percent of total billed charges · outpatientfrom % of charges | 1 | $88 | $99 | $67 | 68% | — | $12 – $212 |
| 4 | ARH Mary Breckinridge Health Services, Inc Martin, KY percent of total billed charges · outpatientfrom % of charges | 1 | $118 | $131 | $89 | 67% | — | $16 – $282 |
| 5 | ARH Tug Valley Health Services, Inc. Paintsville, KY percent of total billed charges · outpatientfrom % of charges | 1 | $82 | $92 | $62 | 68% | — | $11 – $198 |
| 6 | ARH Tug Valley Health Services, Inc. Prestonsburg, KY percent of total billed charges · outpatientfrom % of charges | 1 | $171 | $191 | $129 | 68% | — | $24 – $409 |
| 7 | ARTHUR G JAMES CANCER HOSPITAL AND RESEARCH INSTITUTE Columbus, OH per diem · inpatient | 2 | $5.4k | $5.4k | — | — | — | $5.4k – $5.4k |
| 8 | Adena Fayette Medical Center Washington Court House, OH facility · case rate · outpatient | 1 | $261 | $261 | — | — | — | $261 – $261 |
| 9 | Adena Health System Chillicothe, OH facility · fee schedule · outpatient | 2 | $181 | $181 | $62 | 34% | — | $119 – $244 |
| 10 | Appalachian Regional Healthcare, Inc. Liberty, KY percent of total billed charges · outpatientfrom % of charges | 1 | $124 | $138 | $93 | 67% | — | $17 – $296 |
| 11 | Appalachian Regional Healthcare, Inc. McDowell, KY percent of total billed charges · outpatientfrom % of charges | 1 | $100 | $112 | $75 | 68% | — | $14 – $240 |
| 12 | Appalachian Regional Healthcare, Inc. Middlesboro, KY percent of total billed charges · outpatientfrom % of charges | 1 | $106 | $118 | $80 | 67% | — | $15 – $254 |
| 13 | Appalachian Regional Healthcare, Inc. Williamson, KY percent of total billed charges · outpatientfrom % of charges | 1 | $88 | $99 | $67 | 68% | — | $12 – $212 |
| 14 | Appalachian Regional Healthcare, Inc. Hazard, KY percent of total billed charges · outpatientfrom % of charges | 1 | $130 | $145 | $98 | 67% | — | $18 – $311 |
| 15 | Appalachian Regional Healthcare, Inc. Harlan, KY percent of total billed charges · outpatientfrom % of charges | 1 | $94 | $105 | $71 | 68% | — | $13 – $226 |
| 16 | Baylor Scott & White Medical Center - Centennial Frisco, TX facility · fee schedule · outpatient | 1 | $131 | $131 | — | — | — | $131 – $131 |
| 17 | Baylor Scott & White Medical Center - Lake Pointe Rowlett, TX facility · fee schedule · outpatient | 1 | $131 | $131 | — | — | — | $131 – $131 |
| 18 | Baylor University Medical Center Dallas, TX facility · fee schedule · outpatient | 1 | $131 | $131 | — | — | — | $131 – $131 |
| 19 | CATHOLIC HEALTH INITIATIVES COLORADO West Valley City, UT fee schedule · outpatient | 2 | $196 | $196 | $69 | 35% | — | $127 – $264 |
| 20 | CATHOLIC HEALTH INITIATIVES COLORADO West Jordan, UT fee schedule · outpatient | 2 | $196 | $196 | $69 | 35% | — | $127 – $264 |
| 21 | CATHOLIC HEALTH INITIATIVES COLORADO Lehi, UT fee schedule · outpatient | 2 | $196 | $196 | $69 | 35% | — | $127 – $264 |
| 22 | CATHOLIC HEALTH INITIATIVES COLORADO Layton, UT fee schedule · outpatient | 1 | $264 | $264 | — | — | — | $264 – $264 |
| 23 | CATHOLIC HEALTH INITIATIVES COLORADO Salt Lake City, UT fee schedule · outpatient | 1 | $264 | $264 | — | — | — | $264 – $264 |
| 24 | Carle BroMenn Medical Center Normal, IL case rate · outpatient | 1 | $133 | $133 | — | — | — | $133 – $133 |
| 25 | Catholic Health Initiatives-Iowa Corp Des Moines, IA facility · percent of total billed charges · bothfrom % of charges | 1 | $12 | $12 | — | — | — | $12 – $12 |
← Payers reporting HCPCS Q4142 · Snapshot 20261111T120946Z-9134e7f7