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
$18
Average
$5.1k
Median
$125
High
$180.0k
Each hospital's average Optum rate, under the methodology and billing class chosen below.
37 hospitals; the 90th percentile is 5.4× 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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37 hospital rates
iThe hospitals that file a Optum 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 | ARH Mary Breckinridge Health Services, Inc Barbourville, KY percent of total billed charges · outpatientfrom % of charges | 1 | $99 | $111 | $75 | 67% | — | $14 – $238 |
| 2 | ARH Mary Breckinridge Health Services, Inc Hayden, KY percent of total billed charges · outpatientfrom % of charges | 1 | $87 | $98 | $66 | 68% | — | $12 – $210 |
| 3 | ARH Mary Breckinridge Health Services, Inc Martin, KY percent of total billed charges · outpatientfrom % of charges | 1 | $115 | $129 | $87 | 68% | — | $16 – $277 |
| 4 | Appalachian Regional Healthcare, Inc. Liberty, KY percent of total billed charges · outpatientfrom % of charges | 1 | $122 | $137 | $92 | 67% | — | $17 – $294 |
| 5 | Appalachian Regional Healthcare, Inc. McDowell, KY percent of total billed charges · outpatientfrom % of charges | 1 | $98 | $109 | $74 | 68% | — | $14 – $235 |
| 6 | Appalachian Regional Healthcare, Inc. Hinton, WV percent of total billed charges · outpatientfrom % of charges | 1 | $117 | $130 | $88 | 67% | — | $16 – $280 |
| 7 | Baylor Scott & White Medical Center - Plano Plano, TX facility · percent of total billed charges · outpatientfrom % of charges | 1 | $121 | $2.9k | $7.4k | 254% | — | $70 – $22.5k |
| 8 | Baylor University Medical Center Dallas, TX facility · percent of total billed charges · outpatientfrom % of charges | 1 | $121 | $2.9k | $7.4k | 254% | — | $70 – $22.5k |
| 9 | CATHOLIC HEALTH INIATIVES COLORADO Westminster, CO fee schedule · outpatient | 1 | $125 | $125 | — | — | — | $125 – $125 |
| 10 | CATHOLIC HEALTH INITIATIVES COLORADO Pueblo, CO fee schedule · outpatient | 1 | $125 | $125 | — | — | — | $125 – $125 |
| 11 | CATHOLIC HEALTH INITIATIVES COLORADO Colorado Springs, CO fee schedule · outpatient | 1 | $125 | $125 | — | — | — | $125 – $125 |
| 12 | CATHOLIC HEALTH INITIATIVES COLORADO Frisco, CO fee schedule · outpatient | 1 | $125 | $125 | — | — | — | $125 – $125 |
| 13 | CATHOLIC HEALTH INITIATIVES COLORADO Durango, CO fee schedule · outpatient | 1 | $125 | $125 | — | — | — | $125 – $125 |
| 14 | CATHOLIC HEALTH INITIATIVES COLORADO Lakewood, CO fee schedule · outpatient | 1 | $125 | $125 | — | — | — | $125 – $125 |
| 15 | CATHOLIC HEALTH INITIATIVES COLORADO Colorado Springs, CO fee schedule · outpatient | 1 | $125 | $125 | — | — | — | $125 – $125 |
| 16 | CLAIBORNE MEDICAL CENTER Tazewell, TN fee schedule · outpatient | 1 | $121 | $121 | — | — | — | $121 – $121 |
| 17 | CUMBERLAND MEDICAL CENTER, INC. Crossville, TN fee schedule · outpatient | 1 | $121 | $121 | — | — | — | $121 – $121 |
| 18 | FORT LOUDOUN MEDICAL CENTER Lenoir City, TN fee schedule · outpatient | 1 | $113 | $113 | — | — | — | $113 – $113 |
| 19 | FORT SANDERS REGIONAL MEDICAL CENTER Knoxville, TN fee schedule · outpatient | 1 | $113 | $113 | — | — | — | $113 – $113 |
| 20 | Fisher-Titus Medical Center Norwalk, OH facility · fee schedule · outpatient | 1 | $18 | $18 | — | — | — | $18 – $18 |
| 21 | Holy Name Teaneck, NJ facility · fee schedule · outpatient | 1 | $18 | $18 | — | — | — | $18 – $18 |
| 22 | Johnson Memorial Hospital Stafford Springs, CT facility · percent of total billed charges · bothfrom % of charges | 1 | $45 | $45 | — | — | — | $45 – $45 |
| 23 | LECONTE MEDICAL CENTER Sevierville, TN fee schedule · outpatient | 1 | $121 | $121 | — | — | — | $121 – $121 |
| 24 | LONGMONT UNITED HOSPITAL Longmont, CO fee schedule · outpatient | 1 | $125 | $125 | — | — | — | $125 – $125 |
| 25 | MEDICAL CITY FORT WORTH FORT WORTH, TX percent of total billed charges · outpatientfrom % of charges | 1 | $180.0k | $180.0k | $178.5k | 99% | — | $1.5k – $358.5k |
← Payers reporting HCPCS Q4142 · Snapshot 20261111T120946Z-9134e7f7