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
HC Matrix Amnion 3x4cm Thick <12 Sq Cm>
Low
$150
Average
$258
Median
$218
High
$618
Each hospital's average Ambetter rate, under the methodology and billing class chosen below.
47 hospitals; the 90th percentile is 1.9× 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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47 hospital rates
iThe hospitals that file a Ambetter 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 | Brunswick Community Hospital, LLC Bolivia, NC fee schedule · outpatient | 1 | $300 | $300 | — | — | — | $300 – $300 |
| 2 | Central Community Hospital Elkader, IA facility · percent of total billed charges · bothfrom % of charges | 1 | $596 | $574 | $224 | 39% | — | $306 – $798 |
| 3 | Good Samaritan Hospital Puyallup, WA fee schedule · outpatient | 1 | $285 | $285 | — | — | — | $285 – $285 |
| 4 | Hardin County General Hospital Savannah, TN facility · fee schedule · outpatient | 1 | $181 | $181 | — | — | — | $181 – $181 |
| 5 | Hendrick Medical Center Brownwood, TX facility · case rate · outpatient | 1 | $284 | $284 | — | — | — | $284 – $284 |
| 6 | HonorHealth Florence Medical Center Florence, AZ facility · fee schedule · outpatient | 1 | $189 | $189 | — | — | — | $189 – $189 |
| 7 | Honorhealth Deer Valley Medical Center Phoenix, AZ facility · fee schedule · outpatient | 1 | $189 | $189 | — | — | — | $189 – $189 |
| 8 | Honorhealth Four Peaks Medical Center Mesa, AZ facility · fee schedule · outpatient | 1 | $189 | $189 | — | — | — | $189 – $189 |
| 9 | Honorhealth John C. Lincoln Medical Center Phoenix, AZ facility · fee schedule · outpatient | 1 | $189 | $189 | — | — | — | $189 – $189 |
| 10 | Honorhealth Scottsdale Osborn Medical Center Scottsdale, AZ facility · fee schedule · outpatient | 1 | $189 | $189 | — | — | — | $189 – $189 |
| 11 | Honorhealth Scottsdale Shea Medical Center Scottsdale, AZ facility · fee schedule · outpatient | 1 | $189 | $189 | — | — | — | $189 – $189 |
| 12 | Honorhealth Scottsdale Thompson Peak Med Center Scottsdale, AZ facility · fee schedule · outpatient | 1 | $189 | $189 | — | — | — | $189 – $189 |
| 13 | Honorhealth Sonoran Crossing Medical Center Phoenix, AZ facility · fee schedule · outpatient | 1 | $189 | $189 | — | — | — | $189 – $189 |
| 14 | Indiana University Health Arnett Inc. Lafayette, IN fee schedule · outpatient | 1 | $218 | $218 | — | — | — | $218 – $218 |
| 15 | Indiana University Health Ball Memorial Hospital Inc. Muncie, IN fee schedule · outpatient | 1 | $218 | $218 | — | — | — | $218 – $218 |
| 16 | Indiana University Health Bloomington Inc. Bloomington, IN fee schedule · outpatient | 1 | $218 | $218 | — | — | — | $218 – $218 |
| 17 | Indiana University Health Inc. Martinsville, IN fee schedule · outpatient | 1 | $218 | $218 | — | — | — | $218 – $218 |
| 18 | Indiana University Health North Hospital Inc. Carmel, IN fee schedule · outpatient | 1 | $218 | $218 | — | — | — | $218 – $218 |
| 19 | Indiana University Health West Hospital Inc. Avon, IN fee schedule · outpatient | 1 | $218 | $218 | — | — | — | $218 – $218 |
| 20 | Inspira Medical Center Mullica Hill Hill, NJ fee schedule · outpatient | 1 | $287 | $287 | — | — | — | $287 – $287 |
| 21 | Inspira Medical Center Vineland Vineland, NJ fee schedule · outpatient | 1 | $287 | $287 | — | — | — | $287 – $287 |
| 22 | Mercy Hospital of Franciscan Sisters Inc Oelwein, IA facility · percent of total billed charges · bothfrom % of charges | 1 | $470 | $453 | $177 | 39% | — | $241 – $629 |
| 23 | Mercy Medical Center - Dyersville Dyersville, IA facility · percent of total billed charges · bothfrom % of charges | 1 | $642 | $618 | $241 | 39% | — | $329 – $859 |
| 24 | Mercy Medical Center - New Hampton New Hampton, IA facility · percent of total billed charges · bothfrom % of charges | 1 | $571 | $550 | $215 | 39% | — | $293 – $764 |
| 25 | MultiCare Auburn Medical Center Auburn, WA fee schedule · outpatient | 1 | $283 | $283 | — | — | — | $283 – $283 |
← Payers reporting HCPCS Q4211 · Snapshot 20261111T120946Z-9134e7f7