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
$1.3k
Median
$210
High
$25.7k
Each hospital's average UnitedHealthcare rate, under the methodology and billing class chosen below.
475 hospitals; the 90th percentile is 28.5× 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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574 hospital rates
iThe hospitals that file a UnitedHealthcare 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 | "Savoy Medical Management Group, Inc." Mamou, LA facility · fee schedule · outpatient | 1 | $31 | $31 | — | — | — | $31 – $31 |
| 2 | AMH Cath Labs LLC Arlington, TX case rate · outpatient | 2 | $140 | $140 | $1 | 1% | — | $139 – $142 |
| 3 | ARH Mary Breckinridge Health Services, Inc Barbourville, KY percent of total billed charges · outpatientfrom % of charges | 2 | $192 | $254 | $181 | 71% | — | $23 – $617 |
| 4 | ARH Mary Breckinridge Health Services, Inc Hayden, KY percent of total billed charges · outpatientfrom % of charges | 2 | $213 | $273 | $224 | 82% | — | $15 – $747 |
| 5 | ARH Tug Valley Health Services, Inc. Paintsville, KY percent of total billed charges · outpatientfrom % of charges | 2 | $195 | $256 | $223 | 87% | — | $11 – $728 |
| 6 | ARH Tug Valley Health Services, Inc. Prestonsburg, KY percent of total billed charges · outpatientfrom % of charges | 1 | $257 | $287 | $193 | 68% | — | $35 – $616 |
| 7 | Adena Health System Chillicothe, OH facility · fee schedule · outpatient | 1 | $119 | $119 | — | — | — | $119 – $119 |
| 8 | Alta Newport Hospital, LLC Tustin, CA facility · fee schedule · outpatient | 1 | $127 | $127 | — | — | — | $127 – $127 |
| 9 | Altru Hospital Devils Lake Devils Lake, ND facility · fee schedule · outpatient | 1 | $249 | $249 | — | — | — | $249 – $249 |
| 10 | Appalachian Regional Healthcare, Inc. Liberty, KY percent of total billed charges · outpatientfrom % of charges | 2 | $294 | $377 | $311 | 82% | — | $21 – $1.0k |
| 11 | Appalachian Regional Healthcare, Inc. McDowell, KY percent of total billed charges · outpatientfrom % of charges | 2 | $320 | $399 | $302 | 76% | — | $29 – $1.0k |
| 12 | Appalachian Regional Healthcare, Inc. Hinton, WV percent of total billed charges · outpatientfrom % of charges | 2 | $311 | $406 | $325 | 80% | — | $25 – $1.1k |
| 13 | Appalachian Regional Healthcare, Inc. Beckley, WV percent of total billed charges · outpatientfrom % of charges | 1 | $456 | $509 | $343 | 68% | — | $63 – $1.1k |
| 14 | Appalachian Regional Healthcare, Inc. Middlesboro, KY percent of total billed charges · outpatientfrom % of charges | 1 | $430 | $480 | $324 | 68% | — | $59 – $1.0k |
| 15 | Appalachian Regional Healthcare, Inc. Williamson, KY percent of total billed charges · outpatientfrom % of charges | 1 | $414 | $462 | $312 | 68% | — | $57 – $992 |
| 16 | Appalachian Regional Healthcare, Inc. Hazard, KY percent of total billed charges · outpatientfrom % of charges | 1 | $427 | $477 | $322 | 68% | — | $59 – $1.0k |
| 17 | Appalachian Regional Healthcare, Inc. Harlan, KY percent of total billed charges · outpatientfrom % of charges | 1 | $431 | $480 | $324 | 67% | — | $59 – $1.0k |
| 18 | Aspirus Divine Savior Hospital Portage, WI fee schedule · outpatient | 1 | $210 | $210 | — | — | — | $210 – $210 |
| 19 | Aspirus Eagle River Hospital Eagle River, WI fee schedule · outpatient | 1 | $210 | $210 | — | — | — | $210 – $210 |
| 20 | Aspirus Iron River Hospital Iron River, MI fee schedule · outpatient | 1 | $210 | $210 | — | — | — | $210 – $210 |
| 21 | Aspirus Ironwood Hospital Ironwood, MI fee schedule · outpatient | 1 | $210 | $210 | — | — | — | $210 – $210 |
| 22 | Aspirus Keweenaw Hospital Laurium, MI fee schedule · outpatient | 1 | $210 | $210 | — | — | — | $210 – $210 |
| 23 | Aspirus Langlade Hospital Antigo, WI fee schedule · outpatient | 1 | $210 | $210 | — | — | — | $210 – $210 |
| 24 | Aspirus Medford Hospital Medford, WI fee schedule · outpatient | 1 | $210 | $210 | — | — | — | $210 – $210 |
| 25 | Aspirus Merrill Hospital Merrill, WI fee schedule · outpatient | 1 | $210 | $210 | — | — | — | $210 – $210 |
← Payers reporting HCPCS Q4142 · Snapshot 20261113T090226Z-3ce6c0b8