OBJECTIVES: Biologic graft implants are used in the repair of complex Incisional/Ventral hernias when in the surgeon’s judgment the complexity of the hernia and/or the patient’s risk factors indicate a biologic material provides an opportunity for better outcomes than repair performed with synthetic mesh materials. Our objective was to examine the average cost per discharge of Incisional/Ventral hernia repair when Permacol™ and Strattice™ biological meshes were used.  METHODS: The Premier Perspective™ Database (PPD) was used to track hospital reported costs associated with patient stays for Incisional/Ventral hernia repair utilizing Permacol™ and Strattice™ in the 27 months from April, 2008 through June, 2010.  PPD is the largest hospital-based, service-level comparative database in the USA providing detailed resource utilization and cost data categorized under a patients’ principal and secondary procedure codes.  ICD-9 procedure codes were used to identify patients with Incisional/Ventral hernia repair.  RESULTS: A total of 36,105 patients with a primary procedure code for Incisional/Ventral hernia repair were identified between April, 2008 through June, 2010.   Biologics were used in 4.2% of these patients.  Permacol™ was used 135 patients and Strattice™ was used in 287 patients.  There were no significant differences in patient’s demographics between the two groups.  Mean and median cost per discharge was lower for Permacol™ cases compared to Strattice™ ($19,221 vs. $22,428 for mean and $3,163 vs. $5,102 for median).  Cost of “Central Supply” accounted for approximately 50% of the overall cost in both groups, while “Room and Board” accounted for approximately 22% of the overall cost. CONCLUSIONS: The mean cost of the biologic implant was reported as 42% higher when Strattice™ was used vs when Permacol™ was used ($6,596 vs. $4,659) in Incisional/Ventral hernia repairs.  The mean overall discharge costs was 17% higher when Strattice™ was used vs Permacol™ ($22,428 vs. $19,221).