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
$0
Average
$200
Median
$143
High
$2.1k
Each hospital's average Molina rate, under the methodology and billing class chosen below.
120 hospitals; the 90th percentile is 2.9× 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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128 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 | Adena Fayette Medical Center Washington Court House, OH facility · case rate · outpatient | 1 | $261 | $261 | — | — | — | $261 – $261 |
| 3 | Adena Health System Chillicothe, OH facility · fee schedule · outpatient | 2 | $181 | $181 | $62 | 34% | — | $119 – $244 |
| 4 | CATHOLIC HEALTH INITIATIVES COLORADO West Valley City, UT fee schedule · outpatient | 2 | $196 | $196 | $69 | 35% | — | $127 – $264 |
| 5 | CATHOLIC HEALTH INITIATIVES COLORADO West Jordan, UT fee schedule · outpatient | 2 | $196 | $196 | $69 | 35% | — | $127 – $264 |
| 6 | CATHOLIC HEALTH INITIATIVES COLORADO Lehi, UT fee schedule · outpatient | 2 | $196 | $196 | $69 | 35% | — | $127 – $264 |
| 7 | CATHOLIC HEALTH INITIATIVES COLORADO Layton, UT fee schedule · outpatient | 1 | $264 | $264 | — | — | — | $264 – $264 |
| 8 | CATHOLIC HEALTH INITIATIVES COLORADO Salt Lake City, UT fee schedule · outpatient | 1 | $264 | $264 | — | — | — | $264 – $264 |
| 9 | Carle BroMenn Medical Center Normal, IL case rate · outpatient | 1 | $133 | $133 | — | — | — | $133 – $133 |
| 10 | Catholic Health Initiatives-Iowa Corp Des Moines, IA facility · percent of total billed charges · bothfrom % of charges | 1 | $112 | $108 | $42 | 39% | — | $58 – $151 |
| 11 | Catholic Health Initiatives-Iowa Corp West Des Moines, IA facility · percent of total billed charges · bothfrom % of charges | 1 | $112 | $108 | $42 | 39% | — | $58 – $151 |
| 12 | Central Community Hospital Elkader, IA facility · percent of total billed charges · bothfrom % of charges | 1 | $431 | $415 | $162 | 39% | — | $221 – $577 |
| 13 | Clallam County Public Hospital District 2 DBA Olympic Medical Center Port Angeles, WA fee schedule · outpatient | 1 | $201 | $201 | — | — | — | $201 – $201 |
| 14 | Covenant Medical Center Inc Waterloo, IA facility · percent of total billed charges · bothfrom % of charges | 1 | $141 | $135 | $53 | 39% | — | $72 – $188 |
| 15 | Covenant Medical Center Inc Saginaw, MI facility · case rate · outpatient | 2 | $97 | $97 | $30 | 31% | — | $66 – $127 |
| 16 | Covenant Medical Center Inc Saginaw, MI professional · fee schedule · both | 2 | $116 | $116 | — | — | — | $116 – $116 |
| 17 | Covenant Medical Center Inc Saginaw, MI facility · case rate · outpatient | 2 | $97 | $97 | $30 | 31% | — | $66 – $127 |
| 18 | Covenant Medical Center Inc Saginaw, MI professional · fee schedule · both | 2 | $116 | $116 | — | — | — | $116 – $116 |
| 19 | Diley Ridge Medical Center Canal Winchester, OH facility · percent of total billed charges · bothfrom % of charges | 1 | $298 | $286 | $112 | 39% | — | $153 – $398 |
| 20 | ERIE COUNTY MEDICAL CENTER CORPORATION Buffalo, NY fee schedule · outpatient | 3 | $1.5k | $2.1k | $881 | 42% | — | $1.5k – $3.4k |
| 21 | East Cooper Medical Center LLC Mt Pleasant, SC fee schedule · outpatient | 3 | $118 | $135 | $23 | 17% | — | $118 – $168 |
| 22 | Good Samaritan Hospital Puyallup, WA fee schedule · outpatient | 1 | $149 | $149 | — | — | — | $149 – $149 |
| 23 | Greenfield Area Medical Center Greenfield, OH facility · case rate · outpatient | 1 | $261 | $261 | — | — | — | $261 – $261 |
| 24 | HCA FLORIDA NORTH FLORIDA HOSPITAL GAINESVILLE, FL percent of total billed charges · outpatientfrom % of charges | 1 | $0 | $0 | — | — | — | $0 – $0 |
| 25 | Harborview Medical Center Seattle, WA fee schedule · outpatient | 1 | $288 | $288 | — | — | — | $288 – $288 |
← Payers reporting HCPCS Q4211 · Snapshot 20261111T120946Z-9134e7f7