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
BONE ACELLULAR DERM MATRIX 2X4CM 0.4-1.0MM ALLOMEND-COST PER SQ CM-8SQ CM
Low
$1
Average
$368
Median
$133
High
$6.0k
Each hospital's average Molina rate, under the methodology and billing class chosen below.
129 hospitals; the 90th percentile is 3.6× 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.
Filter by billing methodology
Filter by billing class
137 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 | ARTHUR G JAMES CANCER HOSPITAL AND RESEARCH INSTITUTE Columbus, OH per diem · inpatient | 2 | $5.4k | $5.4k | — | — | — | $5.4k – $5.4k |
| 3 | Adena Fayette Medical Center Washington Court House, OH facility · case rate · outpatient | 1 | $261 | $261 | — | — | — | $261 – $261 |
| 4 | Adena Health System Chillicothe, OH facility · fee schedule · outpatient | 2 | $181 | $181 | $62 | 34% | — | $119 – $244 |
| 5 | Baylor Scott & White Medical Center - Centennial Frisco, TX facility · fee schedule · outpatient | 1 | $131 | $131 | — | — | — | $131 – $131 |
| 6 | Baylor Scott & White Medical Center - Lake Pointe Rowlett, TX facility · fee schedule · outpatient | 1 | $131 | $131 | — | — | — | $131 – $131 |
| 7 | Baylor University Medical Center Dallas, TX facility · fee schedule · outpatient | 1 | $131 | $131 | — | — | — | $131 – $131 |
| 8 | CATHOLIC HEALTH INITIATIVES COLORADO West Valley City, UT fee schedule · outpatient | 2 | $196 | $196 | $69 | 35% | — | $127 – $264 |
| 9 | CATHOLIC HEALTH INITIATIVES COLORADO West Jordan, UT fee schedule · outpatient | 2 | $196 | $196 | $69 | 35% | — | $127 – $264 |
| 10 | CATHOLIC HEALTH INITIATIVES COLORADO Lehi, UT fee schedule · outpatient | 2 | $196 | $196 | $69 | 35% | — | $127 – $264 |
| 11 | CATHOLIC HEALTH INITIATIVES COLORADO Layton, UT fee schedule · outpatient | 1 | $264 | $264 | — | — | — | $264 – $264 |
| 12 | CATHOLIC HEALTH INITIATIVES COLORADO Salt Lake City, UT fee schedule · outpatient | 1 | $264 | $264 | — | — | — | $264 – $264 |
| 13 | Carle BroMenn Medical Center Normal, IL case rate · outpatient | 1 | $133 | $133 | — | — | — | $133 – $133 |
| 14 | Carlsbad Medical Center LLC Carlsbad, NM facility · fee schedule · outpatient | 2 | $245 | $245 | $115 | 47% | — | $130 – $360 |
| 15 | Catholic Health Initiatives-Iowa Corp Des Moines, IA facility · percent of total billed charges · bothfrom % of charges | 1 | $28 | $43 | $73 | 170% | — | $13 – $503 |
| 16 | Catholic Health Initiatives-Iowa Corp West Des Moines, IA facility · percent of total billed charges · bothfrom % of charges | 1 | $28 | $43 | $73 | 170% | — | $13 – $503 |
| 17 | Central Community Hospital Elkader, IA facility · percent of total billed charges · bothfrom % of charges | 1 | $106 | $164 | $280 | 170% | — | $51 – $1.9k |
| 18 | Covenant Medical Center Inc Waterloo, IA facility · percent of total billed charges · bothfrom % of charges | 1 | $35 | $54 | $91 | 170% | — | $17 – $629 |
| 19 | Covenant Medical Center Inc Saginaw, MI facility · case rate · outpatient | 2 | $97 | $97 | $30 | 31% | — | $66 – $127 |
| 20 | Covenant Medical Center Inc Saginaw, MI facility · case rate · outpatient | 2 | $97 | $97 | $30 | 31% | — | $66 – $127 |
| 21 | Diley Ridge Medical Center Canal Winchester, OH facility · percent of total billed charges · bothfrom % of charges | 1 | $72 | $132 | $219 | 165% | — | $33 – $977 |
| 22 | GLENDALE ADVENTIST MEDICAL CENTER Glendale, CA percent of total billed charges · outpatientfrom % of charges | 1 | $4.0k | $4.0k | — | — | — | $4.0k – $4.0k |
| 23 | Good Samaritan Hospital Puyallup, WA fee schedule · outpatient | 1 | $149 | $149 | — | — | — | $149 – $149 |
| 24 | Greenfield Area Medical Center Greenfield, OH facility · case rate · outpatient | 1 | $261 | $261 | — | — | — | $261 – $261 |
| 25 | H. Lee Moffitt Cancer Center and Research Institute Hospital, Inc. Tampa, FL facility · percent of total billed charges · outpatientfrom % of charges | 1 | $790 | $2.4k | $3.2k | 132% | — | $1 – $9.4k |
← Payers reporting HCPCS Q4433 · Snapshot 20261111T120946Z-9134e7f7