MedStar Montgomery Medical Center — price list
← Hospital overviewVerified from MedStar Montgomery Medical Center’s published price file
Includes cash prices, list prices, insurance-negotiated rates. Open any row for plan-level negotiated rates. This is public hospital price transparency data, not a guaranteed estimate of your bill.
How to read these columns
- List
- The hospital’s full undiscounted (gross) charge — rarely what anyone actually pays.
- Cash
- The discounted self-pay price for paying directly, without insurance.
- Negotiated
- Rates agreed with insurers; open a row for plan-level detail. Your share depends on your benefits.
These are the hospital’s published reference prices, not a personalized estimate of your bill.
179 prices shown.
| Service | Code | List price | Cash price | Negotiated range | Allowed (median) | |
|---|---|---|---|---|---|---|
| 1nor admin stepdown bed Inpatient | 10021020 CDM | $357 | $350 | $350 – $357 | — | |
| 1pac admin stepdown bed Inpatient | 10021038 CDM | $357 | $350 | $350 – $357 | — | |
| 3icu admin stepdown bed Inpatient | 10021111 CDM | $357 | $350 | $350 – $357 | — | |
| 3imu admin stepdown bed Inpatient | 10021053 CDM | $357 | $350 | $350 – $357 | — | |
| 3imu intensive care charge Inpatient | 20002010 CDM | $3,026 | $2,965 | $2,965 – $3,026 | — | |
| 3nur admin stepdown bed Inpatient | 10021103 CDM | $357 | $350 | $350 – $357 | — | |
| 3obs admin stepdown bed Inpatient | 10021129 CDM | $357 | $350 | $350 – $357 | — | |
| 3wst admin stepdown bed Inpatient | 10021061 CDM | $357 | $350 | $350 – $357 | — | |
| 4est admin stepdown bed Inpatient | 10021079 CDM | $357 | $350 | $350 – $357 | — | |
| 5est admin stepdown bed Inpatient | 10021087 CDM | $357 | $350 | $350 – $357 | — | |
| 5wst admin stepdown bed Inpatient | 10021137 CDM | $357 | $350 | $350 – $357 | — | |
| 6est admin stepdown bed Inpatient | 10021095 CDM | $357 | $350 | $350 – $357 | — | |
| Admission charge Inpatient | 22100010 CDM | $524 | $514 | $514 – $524 | — | |
| Alloderm cont prf 230 sqcm Outpatient | Q4116 HCPCS | $12,103 | $11,861 | $11,861 – $12,103 | — | |
| Alloderm cont prf md 185 sqcm Outpatient | Q4116 HCPCS | $9,741 | $9,546 | $9,546 – $9,741 | — | |
| Alloderm tiss thk md 48 sqcm Outpatient | Q4116 HCPCS | $4,362 | $4,275 | $4,275 – $4,362 | — | |
| Allogft cryo n/mesh 232 sqcm Outpatient | Q4433 HCPCS | $1,576 | $1,545 | $1,545 – $1,576 | — | |
| Allogft mesh 12 sqcm Outpatient | Q4186 HCPCS | $3,214 | $3,150 | $3,150 – $3,214 | — | |
| Allograft derma ace 28 sqcm Outpatient | Q4126 HCPCS | $4,416 | $4,327 | $4,327 – $4,416 | — | |
| Allograft men withbridge m/rt Outpatient | C1762 HCPCS | $9,542 | $9,351 | $9,351 – $9,542 | — | |
| Drsg matrix bil 1/each 26 sqcm Outpatient | Q4104 HCPCS | $6,333 | $6,207 | $6,207 – $6,333 | — | |
| Drsg matrix bil 1/each 129 sqcm Outpatient | Q4104 HCPCS | $9,518 | $9,328 | $9,328 – $9,518 | — | |
| Drsg matrix bil 5/pk 26 sqcm Outpatient | Q4104 HCPCS | $6,332 | $6,205 | $6,205 – $6,332 | — | |
| Drsg matrix bil 5/pk 129 sqcm Outpatient | Q4104 HCPCS | $8,534 | $8,364 | $8,364 – $8,534 | — | |
| Drsg wnd bilayr 516.128 sqcm Outpatient | Q4104 HCPCS | $23,303 | $22,837 | $22,837 – $23,303 | — | |
| Drsg wnd matrix mesh 25 sqcm Outpatient | Q4104 HCPCS | $5,507 | $5,397 | $5,397 – $5,507 | — | |
| Drsg wnd matrix mesh 125 sqcm Outpatient | Q4104 HCPCS | $9,605 | $9,413 | $9,413 – $9,605 | — | |
| Drsg wnd matrix sgl 26 sqcm Outpatient | Q4108 HCPCS | $5,427 | $5,318 | $5,318 – $5,427 | — | |
| Drsg wnd matrix sgl 129 sqcm Outpatient | Q4108 HCPCS | $7,422 | $7,273 | $7,273 – $7,422 | — | |
| Drsg wnd mesh 516.12 sqcm Outpatient | Q4104 HCPCS | $20,264 | $19,859 | $19,859 – $20,264 | — |