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
OASIS TRI-LAYER SUPPLY PER SQ CM-JD 457 (LOW)
Schenectady, NY
See all hospitals reporting HCPCS Q4124 →Price type
Ellis Hospital’s median price of $52 is 52% below the median hospital's median price ($108), higher than 42% of the 1,421 hospitals reporting HCPCS Q4124. The highlighted bar is where this hospital falls; shaded is the middle 50% of hospitals.
Negotiated rates from the hospital’s own file: 5 payers, 7 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 united healthcare facility · percent of total billed charges · inpatientfrom % of charges | $49 | $49 | — | — | — | $49 – $49 |
| 2 | UnitedHealthcare united healthcare facility · percent of total billed charges · outpatientfrom % of charges | $49 | $49 | — | — | — | $49 – $49 |
| 3 | Aetna aetna facility · percent of total billed charges · outpatientfrom % of charges | $51 | $51 | — | — | — | $51 – $51 |
| 4 | Aetna aetna facility · percent of total billed charges · inpatientfrom % of charges | $52 | $52 | — | — | — | $52 – $52 |
| 5 | Tricare tricare facility · fee schedule · outpatient | $127 | $127 | — | — | — | $127 – $127 |
| 6 | Medicare medicare facility · fee schedule · outpatient | $155 | $155 | — | — | — | $155 – $155 |
| 7 | Blue Cross Blue Shield blue shield senior facility · fee schedule · outpatient | $162 | $162 | — | — | — | $162 – $162 |
Last updated: Jun 25, 2026
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