Amniotic tissue wound graft, per square centimeter at Samaritan Hospital

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-sonnet-5-5
Provider: anthropic
API: message_batches
Reasoning effort: model default
Max output tokens: 4096
Prompt version (hash): 444523875572
Generated: October 20, 2026

Original text from hospital filings

MEMBRANE AMNIOBAND 2X2CM -COST PER SQ CM

Troy, NY

See all hospitals reporting HCPCS Q4151 →

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Pricing by billing methodology

Price type

How this price compares nationally

Samaritan Hospital’s median price of $273 is 42% above the median hospital's median price ($192), higher than 70% of the 1,308 hospitals reporting HCPCS Q4151. The highlighted bar is where this hospital falls; shaded is the middle 50% of hospitals.

Payers reporting HCPCS Q4151 at Samaritan Hospital

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	Aetna aetna medicare advantage facility · percent of total billed charges · bothfrom % of charges	$89	$90	$18	20%	—	$63 – $120
2	UnitedHealthcare uhc essential plan medicaid facility · percent of total billed charges · bothfrom % of charges	$142	$144	$28	20%	—	$101 – $192
3	UnitedHealthcare united healthcare medicaid harp chip facility · percent of total billed charges · bothfrom % of charges	$142	$144	$28	20%	—	$101 – $192
4	Excellus blue shield of ne new york medicare adv facility · percent of total billed charges · bothfrom % of charges	$178	$179	$35	20%	—	$126 – $240
5	Highmark blue shield of ne new york medicare adv facility · percent of total billed charges · bothfrom % of charges	$178	$179	$35	20%	—	$126 – $240
6	Anthem empire bcbs blue access facility · percent of total billed charges · bothfrom % of charges	$267	$269	$53	20%	—	$190 – $359
7	Anthem empire bcbs hmo epo ppo indemnity facility · percent of total billed charges · bothfrom % of charges	$267	$269	$53	20%	—	$190 – $359
8	Blue Cross Blue Shield empire bcbs hmo epo ppo indemnity facility · percent of total billed charges · bothfrom % of charges	$267	$269	$53	20%	—	$190 – $359
9	UnitedHealthcare empire bcbs hmo epo ppo indemnity facility · percent of total billed charges · bothfrom % of charges	$267	$269	$53	20%	—	$190 – $359
10	WellCare wellcare ep 1&2 medicaid facility · percent of total billed charges · bothfrom % of charges	$267	$269	$53	20%	—	$190 – $359
11	Wellmark empire bcbs hmo epo ppo indemnity facility · percent of total billed charges · bothfrom % of charges	$267	$269	$53	20%	—	$190 – $359
12	First Health first health facility · percent of total billed charges · bothfrom % of charges	$285	$287	$56	20%	—	$202 – $383
13	Cigna cigna facility · percent of total billed charges · bothfrom % of charges	$302	$305	$60	20%	—	$215 – $407
14	MultiPlan beech street facility · percent of total billed charges · bothfrom % of charges	$320	$323	$63	20%	—	$228 – $431
15	MultiPlan multiplan facility · percent of total billed charges · bothfrom % of charges	$320	$323	$63	20%	—	$228 – $431
16	Phcs multiplan facility · percent of total billed charges · bothfrom % of charges	$320	$323	$63	20%	—	$228 – $431
17	UnitedHealthcare united healthcare facility · percent of total billed charges · bothfrom % of charges	$356	$359	$70	20%	—	$253 – $479

Last updated: Mar 31, 2026

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