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
GRAFT TISSUE AMNIOTIC X MEMBRANE DUAL LAYER REGN PALINGEN 4X6CM
Hackensack, NJ
See all hospitals reporting HCPCS Q4173 →Price type
Hmh Hospitals Corporation’s median price of $217 is 38% below the median hospital's median price ($350), higher than 33% of the 959 hospitals reporting HCPCS Q4173. The highlighted bar is where this hospital falls; shaded is the middle 50% of hospitals.
Negotiated rates from the hospital’s own file: 7 payers, 14 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 | Clover medicare advantage facility · percent of total billed charges · outpatientfrom % of charges | $65 | $80 | $45 | 57% | — | $35 – $178 |
| 2 | Optum managed medicaid facility · percent of total billed charges · outpatientfrom % of charges | $80 | $98 | $56 | 57% | — | $43 – $218 |
| 3 | Aetna medicare advantage facility · percent of total billed charges · outpatientfrom % of charges | $107 | $132 | $75 | 57% | — | $57 – $293 |
| 4 | Cigna hmo facility · percent of total billed charges · bothfrom % of charges | $123 | $151 | $86 | 57% | — | $66 – $335 |
| 5 | Cigna ppo facility · percent of total billed charges · bothfrom % of charges | $123 | $151 | $86 | 57% | — | $66 – $335 |
| 6 | Aetna asa facility · percent of total billed charges · outpatientfrom % of charges | $155 | $190 | $108 | 57% | — | $83 – $423 |
| 7 | Aetna hmo facility · percent of total billed charges · outpatientfrom % of charges | $155 | $190 | $108 | 57% | — | $83 – $423 |
| 8 | Aetna ppo facility · percent of total billed charges · outpatientfrom % of charges | $155 | $190 | $108 | 57% | — | $83 – $423 |
| 9 | WellCare managed medicaid facility · percent of total billed charges · outpatientfrom % of charges | $163 | $200 | $114 | 57% | — | $87 – $445 |
| 10 | WellCare medicare advantage facility · percent of total billed charges · outpatientfrom % of charges | $163 | $200 | $114 | 57% | — | $87 – $445 |
| 11 | Aetna managed medicaid facility · percent of total billed charges · outpatientfrom % of charges | $177 | $218 | $124 | 57% | — | $95 – $485 |
| 12 | UnitedHealthcare hmo facility · percent of total billed charges · outpatientfrom % of charges | $204 | $251 | $143 | 57% | — | $109 – $559 |
| 13 | Cigna bh facility · percent of total billed charges · outpatientfrom % of charges | $289 | $355 | $202 | 57% | — | $155 – $791 |
| 14 | MultiPlan all products facility · percent of total billed charges · bothfrom % of charges | $307 | $378 | $215 | 57% | — | $165 – $841 |
Last updated: Dec 31, 2025
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