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
$113
Average
$183
Median
$125
High
$701
Each hospital's average Optum rate, under the methodology and billing class chosen below.
26 hospitals; the 90th percentile is 4.1× 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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26 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 | CATHOLIC HEALTH INIATIVES COLORADO Westminster, CO fee schedule · outpatient | 1 | $125 | $125 | — | — | — | $125 – $125 |
| 2 | CATHOLIC HEALTH INITIATIVES COLORADO Pueblo, CO fee schedule · outpatient | 1 | $125 | $125 | — | — | — | $125 – $125 |
| 3 | CATHOLIC HEALTH INITIATIVES COLORADO Colorado Springs, CO fee schedule · outpatient | 1 | $125 | $125 | — | — | — | $125 – $125 |
| 4 | CATHOLIC HEALTH INITIATIVES COLORADO Frisco, CO fee schedule · outpatient | 1 | $125 | $125 | — | — | — | $125 – $125 |
| 5 | CATHOLIC HEALTH INITIATIVES COLORADO Durango, CO fee schedule · outpatient | 1 | $125 | $125 | — | — | — | $125 – $125 |
| 6 | CATHOLIC HEALTH INITIATIVES COLORADO Lakewood, CO fee schedule · outpatient | 1 | $125 | $125 | — | — | — | $125 – $125 |
| 7 | CATHOLIC HEALTH INITIATIVES COLORADO Colorado Springs, CO fee schedule · outpatient | 1 | $125 | $125 | — | — | — | $125 – $125 |
| 8 | CLAIBORNE MEDICAL CENTER Tazewell, TN fee schedule · outpatient | 1 | $121 | $121 | — | — | — | $121 – $121 |
| 9 | CUMBERLAND MEDICAL CENTER, INC. Crossville, TN fee schedule · outpatient | 1 | $121 | $121 | — | — | — | $121 – $121 |
| 10 | FORT LOUDOUN MEDICAL CENTER Lenoir City, TN fee schedule · outpatient | 1 | $113 | $113 | — | — | — | $113 – $113 |
| 11 | FORT SANDERS REGIONAL MEDICAL CENTER Knoxville, TN fee schedule · outpatient | 1 | $113 | $113 | — | — | — | $113 – $113 |
| 12 | Johnson Memorial Hospital Stafford Springs, CT facility · percent of total billed charges · bothfrom % of charges | 1 | $486 | $468 | $183 | 39% | — | $249 – $650 |
| 13 | LECONTE MEDICAL CENTER Sevierville, TN fee schedule · outpatient | 1 | $121 | $121 | — | — | — | $121 – $121 |
| 14 | LONGMONT UNITED HOSPITAL Longmont, CO fee schedule · outpatient | 1 | $125 | $125 | — | — | — | $125 – $125 |
| 15 | METHODIST MEDICAL CENTER OF OAK RIDGE Oak Ridge, TN fee schedule · outpatient | 1 | $113 | $113 | — | — | — | $113 – $113 |
| 16 | MORRISTOWN HAMBLEN HOSPITAL ASSOCIATION Morristown, TN fee schedule · outpatient | 1 | $113 | $113 | — | — | — | $113 – $113 |
| 17 | ORTHOCOLORADO, LLC Lakewood, CO fee schedule · outpatient | 1 | $125 | $125 | — | — | — | $125 – $125 |
| 18 | PARKWEST MEDICAL CENTER Knoxville, TN fee schedule · outpatient | 1 | $113 | $113 | — | — | — | $113 – $113 |
| 19 | PARKWEST MEDICAL CENTER Louisville, TN fee schedule · outpatient | 1 | $113 | $113 | — | — | — | $113 – $113 |
| 20 | Pomerene Hospital Millersburg, OH other · both | 1 | $118 | $118 | — | — | — | $118 – $118 |
| 21 | Public Hospital District NO 2 Skagit County Washington Anacortes, WA facility · fee schedule · outpatient | 3 | $151 | $151 | — | — | — | $151 – $151 |
| 22 | ROANE COUNTY MEDICAL CENTER Harriman, TN fee schedule · outpatient | 1 | $113 | $113 | — | — | — | $113 – $113 |
| 23 | Ronald Reagan UCLA Medical Center Los Angeles, CA fee schedule · outpatient | 1 | $459 | $459 | — | — | — | $459 – $459 |
| 24 | Saint Marys Hospital Waterbury, CT facility · percent of total billed charges · bothfrom % of charges | 1 | $729 | $701 | $274 | 39% | — | $374 – $975 |
| 25 | Santa Monica UCLA Medical Center and Orthopaedic Hospital Santa Monica, CA fee schedule · outpatient | 1 | $459 | $459 | — | — | — | $459 – $459 |
← Payers reporting HCPCS Q4211 · Snapshot 20261111T120946Z-9134e7f7