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HCPCS Q4105
KIT MTRX OMNI W/STPLR 2.5X2.5 - as described in hospitals' own price files.
87hospitals publishing a price
$2,834median cash price
$1,533median typical insurance price
| Hospital | Location | Cash price | Typical insurance | List price | Negotiated range |
|---|---|---|---|---|---|
| Oro Valley Hospital | Oro Valley, AZ | $8.47 | $20.46 | $35.28 | $5.40 - $35.28 |
| George Washington Univ Hospital | Washington, DC | $5,456 | $26.09 | $13,641 | $24.61 - $19,184 |
| Merit Health Natchez | Natchez, MS | $12.60 | $32.20 | $70.00 | $3.50 - $140 |
| Western Arizona Regional Medical Center | Bullhead City, AZ | $10.74 | $53.64 | $89.51 | $10.74 - $89.51 |
| Robert Wood Johnson University Hospital At Hamilton | Hamilton, NJ | $62.41 | - | $381 | $26.86 - $324 |
| Robert Wood Johnson University Hospital - Somerset | Somerville, NJ | $64.35 | - | $381 | $26.86 - $348 |
| Merit Health Wesley | Hattiesburg, MS | $37.49 | $79.16 | $178 | $19.99 - $178 |
| Robert Wood Johnson University Hospital | New Brunswick, NJ | $81.22 | - | $381 | $22.31 - $317 |
| Penn State Health Hampden Medical Center | Enola, PA | $44.52 | $113 | $141 | $36.36 - $520 |
| Penn State Health Holy Spirit Medical Center | Camp Hill, PA | $33.79 | $114 | $141 | $38.87 - $526 |
| Penn State Health St. Joseph | Reading, PA | $36.79 | $118 | $141 | $0.01 - $688 |
| Milton S Hershey Medical Center | Hershey, PA | $42.40 | $123 | $128 | $23.04 - $710 |
| Berger Hospital | Circleville, OH | $136 | - | $209 | - |
| Grady Memorial Hospital | Delaware, OH | $136 | - | $209 | - |
| Hardin Memorial Hospital | Kenton, OH | $136 | - | $209 | - |
| Ohiohealth O'Bleness Hospital | Athens, OH | $136 | - | $209 | - |
| Doctors Hospital | Columbus, OH | $151 | - | $232 | - |
| Dublin Methodist Hospital | Dublin, OH | $151 | - | $232 | - |
| Grant Medical Center | Columbus, OH | $151 | - | $232 | - |
| Riverside Methodist Hospital | Columbus, OH | $151 | - | $232 | - |
| Lakewood Ranch Medical Center | Bradenton, FL | - | $155 | $636 | $23.75 - $34,344 |
| Methodist Hospital Of Sacramento | Sacramento, CA | $401 | - | $1,655 | $11.87 - $1,539 |
| Mercy Hospital Of Folsom | Folsom, CA | $617 | - | $1,655 | $11.87 - $1,655 |
| Chandler Regional Medical Center | Chandler, AZ | $915 | - | $3,300 | $69.36 - $6,109 |
| Providence Cedars Sinai Tarzana Medical Center | Tarzana, CA | $2,103 | - | $6,008 | - |
| Saint John'S Health Center | Santa Monica, CA | $2,103 | - | $6,008 | - |
| Providence Little Co Of Mary Med Ctr San Pedro | San Pedro, CA | $2,103 | - | $6,008 | - |
| Providence Holy Cross Medical Center | Mission Hills, CA | $2,103 | - | $6,008 | - |
| Providence Little Company Of Mary Med Ctr Torrance | Torrance, CA | $2,103 | - | $6,008 | - |
| Providence Saint Joseph Medical Ctr | Burbank, CA | $2,103 | - | $6,008 | - |
| St. Patrick Hospital | Missoula, MT | $2,111 | - | $2,638 | - |
| Chi St. Joseph Health Regional Hospital | Bryan, TX | $2,446 | - | $13,979 | $30.28 - $13,979 |
| Healdsburg Hospital | Healdsburg, CA | $2,531 | - | $4,964 | - |
| Providence Valdez Medical Center | Valdez, AK | $2,578 | - | $3,305 | - |
| Providence Hood River Memorial Hospital | Hood River, OR | $2,714 | - | $3,618 | - |
| Providence Newberg Medical Center | Newberg, OR | $2,714 | - | $3,618 | - |
| Providence Seaside Hospital | Seaside, OR | $2,714 | - | $3,618 | - |
| Providence Medford Medical Center | Medford, OR | $2,714 | - | $3,618 | - |
| Providence Milwaukie Hospital | Milwaukie, OR | $2,714 | - | $3,618 | - |
| Providence St. Vincent Medical Center | Portland, OR | $2,714 | - | $3,618 | - |
| Providence Portland Medical Center | Portland, OR | $2,714 | - | $3,618 | - |
| Providence Willamette Falls Medical Center | Oregon City, OR | $2,714 | - | $3,618 | - |
| Kadlec Regional Medical Center | Richland, WA | $2,761 | - | $3,945 | - |
| Providence St. Mary Medical Center | Walla Walla, WA | $2,834 | - | $4,049 | - |
| Providence Mount Carmel Hospital | Colville, WA | $2,853 | - | $4,075 | - |
| Providence St. Joseph Hospital | Chewelah, WA | $2,853 | - | $4,075 | - |
| Henderson Hospital | Henderson, NV | - | $2,910 | $13,541 | $23.85 - $28,849 |
| Spring Valley Hospital Medical Center | Las Vegas, NV | - | $2,910 | $13,541 | $23.85 - $28,849 |
| Providence Redwood Memorial Hospital | Fortuna, CA | $2,984 | - | $5,852 | - |
| Providence Holy Family Hospital | Spokane, WA | $2,988 | - | $4,269 | - |
| Swedish Edmonds Hospital | Edmonds, WA | $3,041 | - | $6,335 | - |
| Swedish Medical Center / Cherry Hill | Seattle, WA | $3,041 | - | $6,335 | - |
| Swedish Issaquah | Issaquah, WA | $3,041 | - | $6,335 | - |
| Covenant Hospital Levelland | Levelland, TX | $3,281 | - | $7,811 | - |
| Covenant Hospital Plainview | Plainview, TX | $3,281 | - | $7,811 | - |
| Covenant Health Hobbs Hospital | Hobbs, NM | $3,281 | - | $7,811 | - |
| Covenant Medical Center | Lubbock, TX | $3,281 | - | $7,811 | - |
| Grace Surgical Hospital | Lubbock, TX | $3,325 | - | $7,916 | - |
| Providence Mission Hospital | Mission Viejo, CA | $3,467 | - | $7,223 | - |
| St. Mary Medical Center | Long Beach, CA | $3,574 | - | $7,445 | - |
| San Francisco VA Medical Center | San Francisco, CA | $3,696 | - | $6,600 | - |
| San Mateo Medical Center | San Mateo, CA | $3,696 | - | $6,600 | - |
| Tri-City Medical Center | Oceanside, CA | $3,696 | - | $6,600 | - |
| Santa Clara Valley Medical Center | San Jose, CA | $3,696 | - | $6,600 | - |
| Sutter Medical Center, Sacramento | Sacramento, CA | $3,696 | - | $6,600 | - |
| Sutter Roseville Medical Center | Roseville, CA | $3,696 | - | $6,600 | - |
| Providence Queen Of The Valley Medical Center | Napa, CA | $3,837 | - | $7,524 | - |
| Providence St. Jude Medical Center | Fullerton, CA | $3,950 | - | $8,229 | - |
| Providence St. Joseph Hospital | Eureka, CA | $3,969 | - | $8,268 | - |
| Providence Kodiak Island Medical Ctr | Kodiak, AK | $4,075 | - | $5,225 | - |
| Orange County Global Medical Center | Santa Ana, CA | $4,162 | - | $8,004 | - |
| Los Angeles General Medical Center | Los Angeles, CA | $4,162 | - | $8,004 | - |
| Lompoc Valley Medical Center | Lompoc, CA | $4,162 | - | $8,004 | - |
| Petaluma Valley Hospital | Petaluma, CA | $4,170 | - | $8,177 | - |
| Providence Santa Rosa Memorial Hospital | Santa Rosa, CA | $4,170 | - | $8,177 | - |
| Providence Centralia Hospital | Centralia, WA | $4,904 | - | $9,431 | - |
| Providence St. Peter Hospital | Olympia, WA | $4,904 | - | $9,431 | - |
| Providence Regional Medical Center Everett | Everett, WA | $5,013 | - | $9,640 | - |
| Providence Alaska Medical Center | Anchorage, AK | $6,368 | - | $8,164 | - |
| Medstar Union Memorial Hospital | Baltimore, MD | $40,345 | $6,545 | $41,168 | $2,068 - $41,168 |
| Temecula Valley Hospital | Temecula, CA | - | $6,581 | $38,389 | $11.87 - $34,550 |
| Medstar Harbor Hospital | Baltimore, MD | $53,786 | $8,285 | $54,884 | $2,486 - $54,884 |
| Medstar Franklin Square Medical Center | Rosedale, MD | $54,182 | $8,749 | $55,288 | $2,752 - $55,288 |
| Medstar Montgomery Medical Center | Olney, MD | $60,658 | $9,218 | $61,896 | $2,729 - $61,896 |
| Medstar Good Samaritan Hospital | Baltimore, MD | $62,751 | $10,286 | $64,032 | $3,284 - $64,032 |
| Medstar Southern Maryland Hospital Center | Clinton, MD | $89,425 | $13,231 | $91,250 | $3,813 - $91,250 |
| Medstar Saint Mary'S Hospital | Leonardtown, MD | $3,918 | $13,347 | $3,998 | $3,918 - $30,966 |
Prices are from each hospital's own machine-readable price file. Cash price is the published discounted cash price; typical insurance price is the median of the per-plan negotiated rates in the file; list price is the gross charge.
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