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 GRAFT SELECT RESTORE LG PERF THICK 327 SQCM-COST PER SQ CM
Troy, NY
See all hospitals reporting HCPCS Q4100 →Price type
Samaritan Hospital’s median price of $1.1k is 38% below the median hospital's median price ($1.8k), higher than 42% of the 968 hospitals reporting HCPCS Q4100. The highlighted bar is where this hospital falls; shaded is the middle 50% of hospitals.
Negotiated rates from the hospital’s own file: 12 payers, 17 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 | Cigna cigna facility · percent of total billed charges · bothfrom % of charges | $594 | $594 | $522 | 88% | — | $72 – $1.1k |
| 2 | Aetna aetna medicare advantage facility · percent of total billed charges · bothfrom % of charges | $569 | $742 | $677 | 91% | — | $21 – $1.8k |
| 3 | UnitedHealthcare uhc essential plan medicaid facility · percent of total billed charges · bothfrom % of charges | $910 | $1.2k | $1.1k | 91% | — | $34 – $2.9k |
| 4 | UnitedHealthcare united healthcare medicaid harp chip facility · percent of total billed charges · bothfrom % of charges | $910 | $1.2k | $1.1k | 91% | — | $34 – $2.9k |
| 5 | Excellus blue shield of ne new york medicare adv facility · percent of total billed charges · bothfrom % of charges | $1.1k | $1.5k | $1.4k | 91% | — | $42 – $3.6k |
| 6 | Highmark blue shield of ne new york medicare adv facility · percent of total billed charges · bothfrom % of charges | $1.1k | $1.5k | $1.4k | 91% | — | $42 – $3.6k |
| 7 | Anthem empire bcbs blue access facility · percent of total billed charges · bothfrom % of charges | $1.7k | $2.2k | $2.0k | 91% | — | $63 – $5.4k |
| 8 | Anthem empire bcbs hmo epo ppo indemnity facility · percent of total billed charges · bothfrom % of charges | $1.7k | $2.2k | $2.0k | 91% | — | $63 – $5.4k |
| 9 | Blue Cross Blue Shield empire bcbs hmo epo ppo indemnity facility · percent of total billed charges · bothfrom % of charges | $1.7k | $2.2k | $2.0k | 91% | 4–40 | $63 – $5.4k |
| 10 | UnitedHealthcare empire bcbs hmo epo ppo indemnity facility · percent of total billed charges · bothfrom % of charges | $1.7k | $2.2k | $2.0k | 91% | — | $63 – $5.4k |
| 11 | WellCare wellcare ep 1&2 medicaid facility · percent of total billed charges · bothfrom % of charges | $1.7k | $2.2k | $2.0k | 91% | — | $63 – $5.4k |
| 12 | Wellmark empire bcbs hmo epo ppo indemnity facility · percent of total billed charges · bothfrom % of charges | $1.7k | $2.2k | $2.0k | 91% | — | $63 – $5.4k |
| 13 | First Health first health facility · percent of total billed charges · bothfrom % of charges | $1.8k | $2.4k | $2.2k | 91% | — | $68 – $5.8k |
| 14 | MultiPlan beech street facility · percent of total billed charges · bothfrom % of charges | $2.0k | $2.7k | $2.4k | 91% | — | $76 – $6.5k |
| 15 | MultiPlan multiplan facility · percent of total billed charges · bothfrom % of charges | $2.0k | $2.7k | $2.4k | 91% | — | $76 – $6.5k |
| 16 | Phcs multiplan facility · percent of total billed charges · bothfrom % of charges | $2.0k | $2.7k | $2.4k | 91% | — | $76 – $6.5k |
| 17 | UnitedHealthcare united healthcare facility · percent of total billed charges · bothfrom % of charges | $2.3k | $3.0k | $2.7k | 91% | — | $84 – $7.2k |
Last updated: Mar 31, 2026
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