Short answer -- $41,580 is probably the amount the hospital bills insurance for a 16x20cm piece of dermal matrix, but your insurance pays them substantially less than that. You should not be billed for it, but rather your insurance. Long answer -- The hospital pays about $10,000 for these large sheets, but possibly less depending on what priced they have negotiated. I know more about the smaller sheets and facilities I worked at payed $3000 vs $5000 for the same thing. The hospital then essentially, as far as I can tell, "makes up" a price that they bill insurance. The insurance has a limit on what they'll actually pay and the hospital has to accept that assuming they are "in network." A crazy example about costs in healthcare is an EKG (heart electrocardiogram). If you look up costs, you will see anything from $50 to $3000. It is a simple test with stickers and wires and a relatively inexpensive machine ($400 on ebay) that an experienced doctor "reads" or interprets in a matter of seconds or minutes at most.