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
$110
Average
$151
Median
$133
High
$818
Each hospital's average WellCare rate, under the methodology and billing class chosen below.
83 hospitals; the 90th percentile is 1.3× 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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87 hospital rates
iThe hospitals that file a WellCare 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 | 2 | $135 | $135 | $3 | 2% | — | $131 – $138 |
| 2 | CLAIBORNE MEDICAL CENTER Tazewell, TN fee schedule · outpatient | 1 | $127 | $127 | — | — | — | $127 – $127 |
| 3 | CLOVIS COMMUNITY MEDICAL CENTER Clovis, CA facility · case rate · outpatient | 1 | $160 | $160 | — | — | — | $160 – $160 |
| 4 | CUMBERLAND MEDICAL CENTER, INC. Crossville, TN fee schedule · outpatient | 1 | $127 | $127 | — | — | — | $127 – $127 |
| 5 | Canton-Potsdam Hospital Potsdam, NY facility · fee schedule · outpatient | 2 | $123 | $123 | — | — | — | $123 – $123 |
| 6 | Carle BroMenn Medical Center Normal, IL case rate · outpatient | 1 | $133 | $133 | — | — | — | $133 – $133 |
| 7 | Carle Eureka Hospital Eureka, IL case rate · outpatient | 1 | $133 | $133 | — | — | — | $133 – $133 |
| 8 | Children's Hospital of the King's Daughters Norfolk, VA facility · percent of total billed charges · outpatientfrom % of charges | 1 | $110 | $110 | $21 | 19% | — | $89 – $131 |
| 9 | Clallam County Public Hospital District 2 DBA Olympic Medical Center Port Angeles, WA fee schedule · outpatient | 1 | $171 | $171 | — | — | — | $171 – $171 |
| 10 | Cleveland Clinic Weston Hospital Nonprofit Corporation Weston, FL facility · fee schedule · outpatient | 1 | $130 | $130 | — | — | — | $130 – $130 |
| 11 | ERIE COUNTY MEDICAL CENTER CORPORATION Buffalo, NY fee schedule · outpatient | 1 | $155 | $155 | — | — | — | $155 – $155 |
| 12 | F.F. Thompson Hospital Canandaigua, NY fee schedule · outpatient | 1 | $127 | $127 | — | — | — | $127 – $127 |
| 13 | FORT LOUDOUN MEDICAL CENTER Lenoir City, TN fee schedule · outpatient | 1 | $119 | $119 | — | — | — | $119 – $119 |
| 14 | FORT SANDERS REGIONAL MEDICAL CENTER Knoxville, TN fee schedule · outpatient | 1 | $119 | $119 | — | — | — | $119 – $119 |
| 15 | FRESNO COMMUNITY HOSPITAL AND MEDICAL CENTER Fresno, CA facility · fee schedule · outpatient | 1 | $127 | $127 | — | — | — | $127 – $127 |
| 16 | Good Samaritan Hospital Puyallup, WA fee schedule · outpatient | 1 | $149 | $149 | — | — | — | $149 – $149 |
| 17 | Harborview Medical Center Seattle, WA fee schedule · outpatient | 1 | $151 | $151 | — | — | — | $151 – $151 |
| 18 | Holy Cross Hospital-Ft. Lauderdale Ft. Lauderdale, FL facility · percent of total billed charges · bothfrom % of charges | 1 | $850 | $818 | $320 | 39% | — | $436 – $1.1k |
| 19 | INDIAN RIVER MEMORIAL HOSPITAL INC Vero Beach, FL facility · fee schedule · outpatient | 1 | $130 | $130 | — | — | — | $130 – $130 |
| 20 | Indiana University Health Arnett Inc. Lafayette, IN fee schedule · outpatient | 1 | $135 | $135 | — | — | — | $135 – $135 |
| 21 | Indiana University Health Ball Memorial Hospital Inc. Muncie, IN fee schedule · outpatient | 1 | $135 | $135 | — | — | — | $135 – $135 |
| 22 | Indiana University Health Bloomington Inc. Bloomington, IN fee schedule · outpatient | 1 | $135 | $135 | — | — | — | $135 – $135 |
| 23 | Indiana University Health Inc. Martinsville, IN fee schedule · outpatient | 1 | $135 | $135 | — | — | — | $135 – $135 |
| 24 | Indiana University Health North Hospital Inc. Carmel, IN fee schedule · outpatient | 1 | $135 | $135 | — | — | — | $135 – $135 |
| 25 | Indiana University Health West Hospital Inc. Avon, IN fee schedule · outpatient | 1 | $135 | $135 | — | — | — | $135 – $135 |
← Payers reporting HCPCS Q4211 · Snapshot 20261111T120946Z-9134e7f7