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HCPCS Q4170

99999-0921-66 - Amnion Allograft 24 cm2 Misc

Reported by 3 hospitals in the network under the per diem methodology.

Filter by billing methodology

All methodologiesAggregated across all available billing methodologies for this code.Case rateCMS definition: a flat rate for a package of items and services triggered by a diagnosis, treatment, or condition for a designated length of time.Fee scheduleCMS definition: the payer-specific negotiated charge is based on a fee schedule — for example, a Medicare, Medicaid, commercial payer, or workers’ compensation fee schedule.Per diemCMS definition: the per day charge for providing hospital items and services.Percent of billed chargesCMS definition: the payer-specific negotiated charge is based on a percentage of the total billed charges for an item or service, which may vary depending on certain pre-determined criteria being met.OtherCMS definition: used when the standard charge methodology can’t be described by case rate, fee schedule, per diem, or percent of total billed charges.

Reflects a negotiated per diem rate paid per day of care.

National pricing summary

Low

$125

Average

$206

Median

$132

High

$361

Hospitals reporting this code

#HospitalLocation
1Porter Hospital LLCValparaiso, IN$117$132$132$537—
2Granbury Hospital CorporationGranbury, TX$134$361$361$373—
3Las Cruces Medical Center LLCLas Cruces, NM$121$125$125$246—

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