Amniotic membrane graft, per square centimeter at Mercy Hospital Springfield

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

Grft Tis Sft Anmioexcel+ 3x3cm (per Sqcm)

Ozark, MO

See all hospitals reporting HCPCS Q4137 →

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Pricing by billing methodology

Price type

How this price compares nationally

Mercy Hospital Springfield’s median price of $125 is 22% below the median hospital's median price ($159), higher than 27% 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 Mercy Hospital Springfield

Negotiated rates from the hospital’s own file: 14 payers, 24 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	Blue Cross Blue Shield hb sprg medicare facility · fee schedule · outpatient	$108	$108	—	—	—	$108 – $108
2	Aetna hb sprg medicare facility · other · outpatient	$125	$125	—	—	—	$125 – $125
3	Blue Cross Blue Shield hb sprg medicare facility · other · outpatient	$125	$125	—	—	—	$125 – $125
4	Cigna hb sprg medicare facility · other · outpatient	$125	$125	—	—	—	$125 – $125
5	Humana hb sprg humana medicare 100% facility · other · outpatient	$125	$125	—	—	—	$125 – $125
6	Medica hb sprg medicare facility · other · outpatient	$125	$125	—	—	—	$125 – $125
7	Medicare hb sprg medicare facility · other · outpatient	$125	$125	—	—	—	$125 – $125
8	Tricare hb sprg tricare facility · other · outpatient	$125	$125	—	—	—	$125 – $125
9	UnitedHealthcare hb sprg medicare facility · other · outpatient	$125	$125	—	—	—	$125 – $125
10	UnitedHealthcare hb sprg uhc mcr 100% facility · other · outpatient	$125	$125	—	—	—	$125 – $125
11	WellCare hb sprg & lebn wellcare mcr 103% facility · other · outpatient	$129	$129	—	—	—	$129 – $129
12	Devoted hb sprg devoted health medicare advantage 104% w/seq facility · other · outpatient	$130	$130	—	—	—	$130 – $130
13	Medica hb sprg lebn medica exchange facility · percent of total billed charges · outpatientfrom % of charges	$167	$179	$115	64%	—	$47 – $341
14	Ambetter hb sprg ambetter exchange mo facility · percent of total billed charges · outpatientfrom % of charges	$190	$204	$131	64%	—	$53 – $388
15	Anthem hb sprg anthem alliance facility · percent of total billed charges · outpatientfrom % of charges	$190	$204	$131	64%	—	$53 – $388
16	Anthem hb sprg anthem blue access facility · percent of total billed charges · outpatientfrom % of charges	$190	$204	$131	64%	—	$53 – $388
17	Blue Cross Blue Shield hb sprg anthem alliance facility · percent of total billed charges · outpatientfrom % of charges	$190	$204	$131	64%	—	$53 – $388
18	Blue Cross Blue Shield hb sprg anthem blue access facility · percent of total billed charges · outpatientfrom % of charges	$190	$204	$131	64%	—	$53 – $388
19	Blue Cross Blue Shield hb sprg anthem pathways exchange facility · percent of total billed charges · outpatientfrom % of charges	$190	$204	$131	64%	—	$53 – $388
20	Humana hb sprg humana facility · percent of total billed charges · outpatientfrom % of charges	$190	$204	$131	64%	—	$53 – $388
21	Blue Cross Blue Shield hb sprg anthem blue preferred facility · percent of total billed charges · outpatientfrom % of charges	$308	$330	$212	64%	—	$86 – $630
22	First Health hb sprg aetna first health-network access facility · percent of total billed charges · outpatientfrom % of charges	$308	$330	$212	64%	—	$86 – $630
23	Blue Cross Blue Shield hb sprg anthem traditional facility · percent of total billed charges · outpatientfrom % of charges	$322	$346	$222	64%	—	$90 – $659
24	MultiPlan hb sprg phcs (mpi) facility · percent of total billed charges · outpatientfrom % of charges	$342	$366	$235	64%	—	$96 – $699

Last updated: Jun 4, 2026

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