Wound-care dressing, 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-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

MEMBRANE AMNIOTIC BARRIER 4X4CM-Q4163-COST PER SQ CM

Troy, NY

See all hospitals reporting HCPCS Q4163 →

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Pricing by billing methodology

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How this price compares nationally

Samaritan Hospital’s median price of $325 is 57% above the median hospital's median price ($208), higher than 73% of the 1,026 hospitals reporting HCPCS Q4163. The highlighted bar is where this hospital falls; shaded is the middle 50% of hospitals.

Payers reporting HCPCS Q4163 at Samaritan Hospital

Negotiated rates from the hospital’s own file: 8 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.

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1	UnitedHealthcare uhc essential plan medicaid facility · percent of total billed charges · bothfrom % of charges	$170	$175	$86	49%	—	$73 – $333
2	UnitedHealthcare united healthcare medicaid harp chip facility · percent of total billed charges · bothfrom % of charges	$170	$175	$86	49%	—	$73 – $333
3	Anthem empire bcbs hmo epo ppo indemnity facility · percent of total billed charges · bothfrom % of charges	$320	$328	$162	49%	—	$137 – $623
4	Blue Cross Blue Shield empire bcbs hmo epo ppo indemnity facility · percent of total billed charges · bothfrom % of charges	$320	$328	$162	49%	—	$137 – $623
5	UnitedHealthcare empire bcbs hmo epo ppo indemnity facility · percent of total billed charges · bothfrom % of charges	$320	$328	$162	49%	—	$137 – $623
6	Wellmark empire bcbs hmo epo ppo indemnity facility · percent of total billed charges · bothfrom % of charges	$320	$328	$162	49%	—	$137 – $623
7	First Health first health facility · percent of total billed charges · bothfrom % of charges	$341	$350	$172	49%	—	$146 – $665
8	Cigna cigna facility · percent of total billed charges · bothfrom % of charges	$362	$372	$183	49%	—	$155 – $707
9	MultiPlan beech street facility · percent of total billed charges · bothfrom % of charges	$384	$393	$194	49%	—	$164 – $748
10	MultiPlan multiplan facility · percent of total billed charges · bothfrom % of charges	$384	$393	$194	49%	—	$164 – $748
11	Phcs multiplan facility · percent of total billed charges · bothfrom % of charges	$384	$393	$194	49%	—	$164 – $748
12	UnitedHealthcare united healthcare facility · percent of total billed charges · bothfrom % of charges	$426	$437	$215	49%	—	$182 – $831

Last updated: Mar 31, 2026

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