Amniotic membrane 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-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

GRAFT VIASHIELD 2LAYER AMNION PATCH 4X4CM-COST PER SQ CM

Troy, NY

See all hospitals reporting HCPCS Q4211 →

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How this price compares nationally

Samaritan Hospital’s median price of $404 is 200% above the median hospital's median price ($135), higher than 91% of the 530 hospitals reporting HCPCS Q4211. The highlighted bar is where this hospital falls; shaded is the middle 50% of hospitals.

Payers reporting HCPCS Q4211 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	$152	$146	$57	39%	—	$78 – $203
2	UnitedHealthcare uhc essential plan medicaid facility · percent of total billed charges · bothfrom % of charges	$243	$234	$91	39%	—	$125 – $325
3	UnitedHealthcare united healthcare medicaid harp chip facility · percent of total billed charges · bothfrom % of charges	$243	$234	$91	39%	—	$125 – $325
4	Excellus blue shield of ne new york medicare adv facility · percent of total billed charges · bothfrom % of charges	$304	$292	$114	39%	—	$156 – $406
5	Highmark blue shield of ne new york medicare adv facility · percent of total billed charges · bothfrom % of charges	$304	$292	$114	39%	—	$156 – $406
6	Anthem empire bcbs blue access facility · percent of total billed charges · bothfrom % of charges	$455	$438	$171	39%	—	$234 – $609
7	Anthem empire bcbs hmo epo ppo indemnity facility · percent of total billed charges · bothfrom % of charges	$455	$438	$171	39%	—	$234 – $609
8	Blue Cross Blue Shield empire bcbs hmo epo ppo indemnity facility · percent of total billed charges · bothfrom % of charges	$455	$438	$171	39%	—	$234 – $609
9	UnitedHealthcare empire bcbs hmo epo ppo indemnity facility · percent of total billed charges · bothfrom % of charges	$455	$438	$171	39%	—	$234 – $609
10	WellCare wellcare ep 1&2 medicaid facility · percent of total billed charges · bothfrom % of charges	$455	$438	$171	39%	—	$234 – $609
11	Wellmark empire bcbs hmo epo ppo indemnity facility · percent of total billed charges · bothfrom % of charges	$455	$438	$171	39%	—	$234 – $609
12	First Health first health facility · percent of total billed charges · bothfrom % of charges	$486	$468	$183	39%	—	$249 – $650
13	Cigna cigna facility · percent of total billed charges · bothfrom % of charges	$516	$497	$194	39%	—	$265 – $691
14	MultiPlan beech street facility · percent of total billed charges · bothfrom % of charges	$546	$526	$205	39%	—	$280 – $731
15	MultiPlan multiplan facility · percent of total billed charges · bothfrom % of charges	$546	$526	$205	39%	—	$280 – $731
16	Phcs multiplan facility · percent of total billed charges · bothfrom % of charges	$546	$526	$205	39%	—	$280 – $731
17	UnitedHealthcare united healthcare facility · percent of total billed charges · bothfrom % of charges	$607	$585	$228	39%	—	$311 – $813

Last updated: Mar 31, 2026

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