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
Dl amnio bur x-mem per sq cm
Grayling, MI
See all hospitals reporting HCPCS Q4366 →Price type
Munson Healthcare Grayling’s median price of $124 is 8% below the median hospital's median price ($135), higher than 30% of the 412 hospitals reporting HCPCS Q4366. The highlighted bar is where this hospital falls; shaded is the middle 50% of hospitals.
Negotiated rates from the hospital’s own file: 6 payers, 12 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.
Filter by billing methodology
Filter by billing class
| # | |||||||
|---|---|---|---|---|---|---|---|
| 1 | Blue Cross Blue Shield managed medicaid facility · fee schedule · outpatient | $65 | $65 | — | — | — | $65 – $65 |
| 2 | Molina managed medicaid facility · fee schedule · outpatient | $65 | $65 | — | — | — | $65 – $65 |
| 3 | UnitedHealthcare managed medicaid facility · fee schedule · outpatient | $65 | $65 | — | — | — | $65 – $65 |
| 4 | Aetna medicare advantage professional · fee schedule · both | $116 | $116 | — | — | — | $116 – $116 |
| 5 | Humana medicare advantage professional · fee schedule · both | $116 | $116 | — | — | — | $116 – $116 |
| 6 | Molina medicare advantage professional · fee schedule · both | $116 | $116 | — | — | — | $116 – $116 |
| 7 | WellCare medicare advantage professional · fee schedule · both | $116 | $116 | — | — | — | $116 – $116 |
| 8 | Aetna medicare advantage facility · fee schedule · outpatient | $124 | $124 | — | — | — | $124 – $124 |
| 9 | Humana medicare advantage facility · fee schedule · outpatient | $124 | $124 | — | — | — | $124 – $124 |
| 10 | UnitedHealthcare medicare advantage facility · fee schedule · outpatient | $124 | $124 | — | — | — | $124 – $124 |
| 11 | WellCare medicare advantage facility · fee schedule · outpatient | $124 | $124 | — | — | — | $124 – $124 |
| 12 | Molina medicare advantage facility · fee schedule · outpatient | $134 | $134 | — | — | — | $134 – $134 |
Last updated: Apr 17, 2026
See Amniotic membrane graft, dual layer, per square centimeter pricing across every hospital in the network reporting it, or ask Claude or any MCP client directly — see how to connect.