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
Palingen dual-layer membrane and dual-layer palingen x-membrane, per square centimeter (add-on, list separately in addition to primary procedure)
Low
$116
Average
$141
Median
$135
High
$191
Each hospital's average WellCare rate, under the methodology and billing class chosen below.
91 hospitals; the 90th percentile is 1.6× 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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95 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 | Clallam County Public Hospital District 2 DBA Olympic Medical Center Port Angeles, WA fee schedule · outpatient | 1 | $171 | $171 | — | — | — | $171 – $171 |
| 9 | Cleveland Clinic Weston Hospital Nonprofit Corporation Weston, FL facility · fee schedule · outpatient | 1 | $130 | $130 | — | — | — | $130 – $130 |
| 10 | ERIE COUNTY MEDICAL CENTER CORPORATION Buffalo, NY fee schedule · outpatient | 1 | $155 | $155 | — | — | — | $155 – $155 |
| 11 | F.F. Thompson Hospital Canandaigua, NY fee schedule · outpatient | 1 | $127 | $127 | — | — | — | $127 – $127 |
| 12 | FORT LOUDOUN MEDICAL CENTER Lenoir City, TN fee schedule · outpatient | 1 | $119 | $119 | — | — | — | $119 – $119 |
| 13 | FORT SANDERS REGIONAL MEDICAL CENTER Knoxville, TN fee schedule · outpatient | 1 | $119 | $119 | — | — | — | $119 – $119 |
| 14 | FRESNO COMMUNITY HOSPITAL AND MEDICAL CENTER Fresno, CA facility · fee schedule · outpatient | 1 | $127 | $127 | — | — | — | $127 – $127 |
| 15 | Good Samaritan Hospital Puyallup, WA fee schedule · outpatient | 1 | $149 | $149 | — | — | — | $149 – $149 |
| 16 | HMH HOSPITALS CORPORATION Hackensack, NJ facility · percent of total billed charges · outpatientfrom % of charges | 2 | $191 | $191 | $22 | 12% | — | $169 – $213 |
| 17 | HMH HOSPITALS CORPORATION Red Bank, NJ facility · percent of total billed charges · outpatientfrom % of charges | 2 | $191 | $191 | $22 | 12% | — | $169 – $213 |
| 18 | HMH HOSPITALS CORPORATION Edison, NJ facility · percent of total billed charges · outpatientfrom % of charges | 2 | $191 | $191 | $22 | 12% | — | $169 – $213 |
| 19 | HMH HOSPITALS CORPORATION Manahawkin, NJ facility · percent of total billed charges · bothfrom % of charges | 2 | $191 | $191 | $22 | 12% | — | $169 – $213 |
| 20 | HMH HOSPITALS CORPORATION Brick, NJ facility · percent of total billed charges · outpatientfrom % of charges | 2 | $191 | $191 | $22 | 12% | — | $169 – $213 |
| 21 | HMH HOSPITALS CORPORATION Neptune City, NJ facility · percent of total billed charges · outpatientfrom % of charges | 2 | $191 | $191 | $22 | 12% | — | $169 – $213 |
| 22 | HMH HOSPITALS CORPORATION Edison, NJ facility · percent of total billed charges · outpatientfrom % of charges | 2 | $191 | $191 | $22 | 12% | — | $169 – $213 |
| 23 | HMH HOSPITALS CORPORATION North Bergen, NJ facility · percent of total billed charges · bothfrom % of charges | 2 | $191 | $191 | $22 | 12% | — | $169 – $213 |
| 24 | HMH HOSPITALS CORPORATION Holmdel, NJ facility · percent of total billed charges · outpatientfrom % of charges | 2 | $191 | $191 | $22 | 12% | — | $169 – $213 |
| 25 | HMH HOSPITALS CORPORATION Old Bridge, NJ facility · percent of total billed charges · outpatientfrom % of charges | 2 | $191 | $191 | $22 | 12% | — | $169 – $213 |
← Payers reporting HCPCS Q4354 · Snapshot 20261112T181611Z-3fa9fb76