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
Amnioplast 3, per square centimeter (add-on, list separately in addition to primary procedure)
Low
$0
Average
$83
Median
$88
High
$1.0k
Each hospital's average Blue Cross Blue Shield rate, under the methodology and billing class chosen below.
123 hospitals; the 90th percentile is 21.7× 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.
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125 hospital rates
iThe hospitals that file a Blue Cross Blue Shield rate for this code, one row per hospital and set of terms (billing class, payment method, setting). Rates under different terms are never blended, so the terms are shown under each hospital’s name. Figures are the hospital’s averages across its plans.| # | Plans | |||||||
|---|---|---|---|---|---|---|---|---|
| 1 | AMH Cath Labs LLC Arlington, TX case rate · outpatient | 1 | $125 | $125 | — | — | — | $125 – $125 |
| 2 | Bethesda Hospital Inc. Lebanon, OH facility · fee schedule · outpatient | 4 | $286 | $270 | $76 | 28% | — | $152 – $356 |
| 3 | Brunswick Community Hospital, LLC Bolivia, NC fee schedule · outpatient | 1 | $133 | $133 | — | — | — | $133 – $133 |
| 4 | CLAIBORNE MEDICAL CENTER Tazewell, TN fee schedule · outpatient | 6 | $127 | $127 | — | — | — | $127 – $127 |
| 5 | CLOVIS COMMUNITY MEDICAL CENTER Clovis, CA facility · case rate · outpatient | 1 | $160 | $160 | — | — | — | $160 – $160 |
| 6 | CUMBERLAND MEDICAL CENTER, INC. Crossville, TN fee schedule · outpatient | 6 | $127 | $127 | — | — | — | $127 – $127 |
| 7 | Carle BroMenn Medical Center Normal, IL case rate · outpatient | 1 | $133 | $133 | — | — | — | $133 – $133 |
| 8 | FORT LOUDOUN MEDICAL CENTER Lenoir City, TN fee schedule · outpatient | 6 | $119 | $119 | — | — | — | $119 – $119 |
| 9 | FORT SANDERS REGIONAL MEDICAL CENTER Knoxville, TN fee schedule · outpatient | 6 | $119 | $119 | — | — | — | $119 – $119 |
| 10 | FRESNO COMMUNITY HOSPITAL AND MEDICAL CENTER Fresno, CA facility · fee schedule · outpatient | 1 | $127 | $127 | — | — | — | $127 – $127 |
| 11 | Forsyth Memorial Hospital, Inc. Clemmons, NC fee schedule · outpatient | 1 | $121 | $121 | — | — | — | $121 – $121 |
| 12 | Forsyth Memorial Hospital, Inc. Winston-Salem, NC fee schedule · outpatient | 1 | $121 | $121 | — | — | — | $121 – $121 |
| 13 | Forsyth Memorial Hospital, Inc. Kernersville, NC fee schedule · outpatient | 1 | $121 | $121 | — | — | — | $121 – $121 |
| 14 | HCA FLORIDA NORTH FLORIDA HOSPITAL GAINESVILLE, FL percent of total billed charges · outpatientfrom % of charges | 9 | $0 | $0 | $0 | 38% | — | $0 – $0 |
| 15 | HCA HOUSTON HEALTHCARE CLEAR LAKE WEBSTER, TX fee schedule · outpatient | 5 | $10 | $9 | $1 | 16% | — | $7 – $11 |
| 16 | HCA HOUSTON HEALTHCARE CONROE CONROE, TX fee schedule · outpatient | 5 | $10 | $9 | $1 | 16% | — | $7 – $11 |
| 17 | HCA HOUSTON HEALTHCARE KINGWOOD KINGWOOD, TX fee schedule · outpatient | 5 | $10 | $9 | $1 | 16% | — | $7 – $11 |
| 18 | HCA HOUSTON HEALTHCARE MEDICAL CENTER HOUSTON, TX fee schedule · outpatient | 5 | $10 | $9 | $1 | 16% | — | $7 – $11 |
| 19 | HCA HOUSTON HEALTHCARE NORTHWEST HOUSTON, TX fee schedule · outpatient | 5 | $10 | $9 | $1 | 16% | — | $7 – $11 |
| 20 | HCA HOUSTON HEALTHCARE PEARLAND HOUSTON, TX fee schedule · outpatient | 5 | $10 | $9 | $1 | 16% | — | $7 – $11 |
| 21 | HCA HOUSTON HEALTHCARE SOUTHEAST HOUSTON, TX fee schedule · outpatient | 5 | $10 | $9 | $1 | 16% | — | $7 – $11 |
| 22 | HCA HOUSTON HEALTHCARE TOMBALL Tomball, TX fee schedule · outpatient | 5 | $10 | $9 | $1 | 16% | — | $7 – $11 |
| 23 | HCA HOUSTON HEALTHCARE WEST STAFFORD, TX fee schedule · outpatient | 5 | $10 | $9 | $1 | 16% | — | $7 – $11 |
| 24 | HCA HOUSTON MAINLAND Texas City, TX fee schedule · outpatient | 5 | $10 | $9 | $1 | 16% | — | $7 – $11 |
| 25 | HCA Houston Healthcare North Cypress CYPRESS, TX fee schedule · outpatient | 5 | $10 | $9 | $1 | 16% | — | $7 – $11 |
← Payers reporting HCPCS Q4369 · Snapshot 20261112T181611Z-3fa9fb76