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
ALLODRM 400SQ11090X-12199
Low
$0
Average
$916
Median
$131
High
$27.8k
Filter by billing methodology
Reflects negotiated fee schedule rates with commercial payers.
Showing only prices reported under the fee schedule methodology. Choose another in the filter above to change the chart. 1347 hospitals; the 90th percentile is 31.7× 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.
Click a bar to filter the hospitals table to that price range.
| # | Hospital | ||||||
|---|---|---|---|---|---|---|---|
| 1 | Dignity Community Care Sacramento, CA | $3.0k | $10.4k | $16.2k | 155% | 72–720 | $26 – $84.8k |
| 2 | Public Hospital Dis No 1 Skagit dba Skagit Valley Hospital Vernon, WA | $15.3k | $19.7k | $10.6k | 54% | 60–600 | $283 – $38.9k |
| 3 | Alegent Creighton Health Omaha, NE | $1.5k | $3.4k | $5.0k | 145% | 58–400 | $22 – $36.9k |
| 4 | Alegent Creighton Health Papillion, NE | $1.6k | $3.5k | $5.0k | 144% | 38–380 | $24 – $36.9k |
| 5 | Dignity Health Gilbert, AZ | $1.3k | $10.0k | $20.0k | 201% | 36–360 | $39 – $125.1k |
| 6 | Dignity Community Care Chandler, AZ | $1.7k | $10.9k | $21.5k | 198% | 30–192 | $39 – $136.5k |
| 7 | Saint Elizabeth Regional Medical Center Lincoln, NE | $1.8k | $3.3k | $4.8k | 143% | 26–260 | $32 – $36.9k |
| 8 | Good Samaritan Hospital Kearney, NE | $3.6k | $5.2k | $6.7k | 129% | 26–260 | $26 – $40.4k |
| 9 | Chi St. Luke's Health Baylor College Of Medicine Medical Center Houston, TX | $6.5k | $14.2k | $18.0k | 127% | 26–260 | $32 – $116.9k |
| 10 | Avera McKennan Hospital Sioux Falls, SD | $31 | $7.3k | $10.3k | 141% | 21–210 | $31 – $26.8k |
Ask Claude or any MCP client for HCPCS Q4116 pricing at a specific hospital — see how to connect.