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
TISSUE SURGIMEND PRS 10 X 20 CM
Troy, NY
See all hospitals reporting HCPCS C1763 →Price type
Samaritan Hospital’s median price of $2.1k is 19% below the median hospital's median price ($2.6k), higher than 41% of the 1,482 hospitals reporting HCPCS C1763. The highlighted bar is where this hospital falls; shaded is the middle 50% of hospitals.
Negotiated rates from the hospital’s own file: 15 payers, 26 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 essential plan medicaid facility · percent of total billed charges · bothfrom % of charges | $2.0k | $3.1k | $4.0k | 128% | — | $11 – $21.6k |
| 2 | UnitedHealthcare united healthcare medicaid harp chip facility · percent of total billed charges · bothfrom % of charges | $2.0k | $3.1k | $4.0k | 128% | — | $11 – $21.6k |
| 3 | Blue Cross Blue Shield blue shield of ne new york hmo facility · percent of total billed charges · bothfrom % of charges | $2.0k | $3.1k | $4.0k | 128% | — | $15 – $21.6k |
| 4 | Blue Cross Blue Shield blue shield of ne new york ppo facility · percent of total billed charges · bothfrom % of charges | $2.0k | $3.1k | $4.0k | 128% | 138–1,380 | $15 – $21.6k |
| 5 | Carefirst blue shield of ne new york hmo facility · percent of total billed charges · bothfrom % of charges | $2.0k | $3.1k | $4.0k | 128% | — | $15 – $21.6k |
| 6 | Carefirst blue shield of ne new york ppo facility · percent of total billed charges · bothfrom % of charges | $2.0k | $3.1k | $4.0k | 128% | — | $15 – $21.6k |
| 7 | Excellus blue shield of ne new york ppo facility · percent of total billed charges · bothfrom % of charges | $2.0k | $3.1k | $4.0k | 128% | — | $15 – $21.6k |
| 8 | Highmark blue shield of ne new york ascend facility · percent of total billed charges · bothfrom % of charges | $2.0k | $3.1k | $4.0k | 128% | — | $15 – $21.6k |
| 9 | Highmark blue shield of ne new york hmo facility · percent of total billed charges · bothfrom % of charges | $2.0k | $3.1k | $4.0k | 128% | — | $15 – $21.6k |
| 10 | Highmark blue shield of ne new york ppo facility · percent of total billed charges · bothfrom % of charges | $2.0k | $3.1k | $4.0k | 128% | 138–1,380 | $15 – $21.6k |
| 11 | Premera blue shield of ne new york ppo facility · percent of total billed charges · bothfrom % of charges | $2.0k | $3.1k | $4.0k | 128% | — | $15 – $21.6k |
| 12 | Regence blue shield of ne new york ppo facility · percent of total billed charges · bothfrom % of charges | $2.0k | $3.1k | $4.0k | 128% | — | $15 – $21.6k |
| 13 | Wellmark blue shield of ne new york hmo facility · percent of total billed charges · bothfrom % of charges | $2.0k | $3.1k | $4.0k | 128% | — | $15 – $21.6k |
| 14 | Wellmark blue shield of ne new york ppo facility · percent of total billed charges · bothfrom % of charges | $2.0k | $3.1k | $4.0k | 128% | — | $15 – $21.6k |
| 15 | Cigna cigna facility · percent of total billed charges · bothfrom % of charges | $2.0k | $3.1k | $4.0k | 128% | 138–1,380 | $23 – $21.6k |
| 16 | Aetna aetna facility · percent of total billed charges · bothfrom % of charges | $2.0k | $3.1k | $4.0k | 127% | — | $44 – $21.6k |
| 17 | Medical Mutual aetna facility · percent of total billed charges · bothfrom % of charges | $2.0k | $3.1k | $4.0k | 127% | — | $44 – $21.6k |
| 18 | UnitedHealthcare united healthcare facility · percent of total billed charges · bothfrom % of charges | $3.2k | $6.0k | $8.2k | 137% | — | $15 – $54.1k |
| 19 | First Health first health facility · percent of total billed charges · bothfrom % of charges | $3.9k | $6.2k | $8.0k | 128% | — | $22 – $43.2k |
| 20 | MultiPlan beech street facility · percent of total billed charges · bothfrom % of charges | $4.4k | $7.0k | $9.0k | 128% | — | $24 – $48.6k |
| 21 | MultiPlan multiplan facility · percent of total billed charges · bothfrom % of charges | $4.4k | $7.0k | $9.0k | 128% | — | $24 – $48.6k |
| 22 | Phcs multiplan facility · percent of total billed charges · bothfrom % of charges | $4.4k | $7.0k | $9.0k | 128% | — | $24 – $48.6k |
| 23 | Anthem empire medicaid facility · percent of total billed charges · bothfrom % of charges | $4.9k | $7.8k | $10.0k | 128% | — | $27 – $54.1k |
| 24 | Anthem empire medicaid essential 1 2 3 4 facility · percent of total billed charges · bothfrom % of charges | $4.9k | $7.8k | $10.0k | 128% | — | $27 – $54.1k |
| 25 | Excellus empire medicaid facility · percent of total billed charges · bothfrom % of charges | $4.9k | $7.8k | $10.0k | 128% | — | $27 – $54.1k |
Last updated: Mar 31, 2026
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