Amniotic membrane graft, per square centimeter at Affinity Hospital LLC

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.

Model: claude-haiku-5-5
Provider: anthropic
API: message_batches
Reasoning effort: low
Max output tokens: 4096
Prompt version (hash): 444523875572
Generated: October 20, 2026

Original text from hospital filings

AMNIO/BIO EXCEL SQCM

Birmingham, AL

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Pricing by billing methodology

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How this price compares nationally

Affinity Hospital LLC’s median price of $173 is 9% above the median hospital's median price ($159), higher than 55% of the 1,253 hospitals reporting HCPCS Q4137. The highlighted bar is where this hospital falls; shaded is the middle 50% of hospitals.

Payers reporting HCPCS Q4137 at Affinity Hospital LLC

Negotiated rates from the hospital’s own file: 13 payers, 22 plan rates. A facility fee, a professional fee, a per diem and a case rate are different bills, so each is listed on its own. Open a payer to see it across hospitals.

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1	UnitedHealthcare uhc iex facility · percent of total billed charges · outpatientfrom % of charges	$66	$66	—	—	—	$66 – $66
2	UnitedHealthcare uhc apa facility · percent of total billed charges · outpatientfrom % of charges	$75	$75	—	—	—	$75 – $75
3	Humana node humana mcr adv facility · fee schedule · outpatient	$112	$112	—	—	—	$112 – $112
4	UnitedHealthcare node uhc mcr adv facility · per diem · outpatient	$112	$112	—	—	—	$112 – $112
5	Optum node united optum va ccn facility · fee schedule · outpatient	$114	$114	—	—	—	$114 – $114
6	Cigna Healthspring node cigna healthspring mcr adv facility · fee schedule · outpatient	$114	$114	—	—	—	$114 – $114
7	Devoted node devoted health mcr adv facility · fee schedule · outpatient	$114	$114	—	—	—	$114 – $114
8	Clover node clover health mcr adv facility · fee schedule · outpatient	$115	$115	—	—	—	$115 – $115
9	Aetna node aetna mcr adv facility · fee schedule · outpatient	$115	$115	—	—	—	$115 – $115
10	WellCare node wellcare mcr adv facility · fee schedule · outpatient	$116	$116	—	—	—	$116 – $116
11	Aetna aetna all facility · per diem · outpatient	$122	$122	—	—	—	$122 – $122
12	Tricare node tricare facility · fee schedule · outpatient	$127	$127	—	—	—	$127 – $127
13	WellCare node wellcare ambetter marketplace facility · fee schedule · outpatient	$171	$171	—	—	—	$171 – $171
14	Optum optum health facility · percent of total billed charges · outpatientfrom % of charges	$197	$197	—	—	—	$197 – $197
15	Cigna cigna all facility · fee schedule · outpatient	$199	$199	—	—	—	$199 – $199
16	First Health first health facility · other · outpatient	$263	$263	—	—	—	$263 – $263
17	MultiPlan multiplan primary facility · percent of total billed charges · inpatientfrom % of charges	$267	$267	—	—	—	$267 – $267
18	MultiPlan multiplan primary facility · percent of total billed charges · outpatientfrom % of charges	$272	$272	—	—	—	$272 – $272
19	MultiPlan multiplan complementary facility · percent of total billed charges · inpatientfrom % of charges	$307	$307	—	—	—	$307 – $307
20	MultiPlan multiplan complementary facility · percent of total billed charges · outpatientfrom % of charges	$307	$307	—	—	—	$307 – $307
21	First Health first health work comp al facility · percent of total billed charges · outpatientfrom % of charges	$343	$343	—	—	—	$343 – $343
22	Bcbs Al bcbs al all facility · other · outpatient	$438	$438	—	—	—	$438 – $438

Last updated: Apr 1, 2026

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