Skin substitute graft application to face, scalp, or hands, up to 100 sq cm

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

Low cost skin substitute app

Tricare pricing summary

Low

$139

Average

$19.6k

Median

$669

High

$50k

Tricare rate distribution

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27 hospital rates

#		Plans
1	Baptist Medical Center-Attala Kosciusko, MS facility · percent of total billed charges · outpatientfrom % of charges	1	$143	$143	—	—	—	$143 – $143
2	Baptist Medical Center-Yazoo Yazoo City, MS facility · percent of total billed charges · outpatientfrom % of charges	1	$139	$139	—	—	—	$139 – $139
3	Baptist Memorial Hospital - Leake Carthage, MS facility · percent of total billed charges · outpatientfrom % of charges	1	$139	$139	—	—	—	$139 – $139
4	Bon Secours Community Hospital Jervis, NY facility · fee schedule · outpatient	1	$50k	$50k	—	—	—	$50k – $50k
5	CentraState Medical Center Freehold Township, NJ other · outpatient	2	$669	$669	—	—	—	$669 – $669
6	Charleston Area Medical Center Charleston, WV percent of total billed charges · bothfrom % of charges	1	$245	$245	$17	7%	—	$227 – $262
7	Chilton Medical Center Pompton Plains, NJ other · outpatient	2	$669	$669	—	—	—	$669 – $669
8	Doylestown Hospital Doylestown, PA facility · fee schedule · outpatient	1	$490	$490	—	—	—	$490 – $490
9	Fisher-Titus Medical Center Norwalk, OH facility · percent of total billed charges · inpatientfrom % of charges	1	$294	$294	—	—	—	$294 – $294
10	Fisher-Titus Medical Center Norwalk, OH facility · percent of total billed charges · outpatientfrom % of charges	1	$276	$276	—	—	—	$276 – $276
11	GUTHRIE CORTLAND MEDICAL CENTER Cortland, NY facility · other · outpatient	1	$801	$801	—	—	—	$801 – $801
12	Good Samaritan Hospital Suffern, NY facility · fee schedule · outpatient	1	$50k	$50k	—	—	—	$50k – $50k
13	Hackettstown Medical Center Hackettstown, NJ other · outpatient	2	$669	$669	—	—	—	$669 – $669
14	Mid Hudson Regional Hospital Poughkeepsie, NY facility · fee schedule · outpatient	1	$50k	$50k	—	—	—	$50k – $50k
15	Morristown Medical Center Morristown, NJ other · outpatient	2	$669	$669	—	—	—	$669 – $669
16	Newton Medical Center Newton, NJ other · outpatient	2	$669	$669	—	—	—	$669 – $669
17	Northside Hospital, Inc. Lawrenceville, GA fee schedule · outpatient	1	$50k	$50k	—	—	—	$50k – $50k
18	Northside Hospital, Inc. Atlanta, GA fee schedule · outpatient	1	$50k	$50k	—	—	—	$50k – $50k
19	Northside Hospital, Inc. Cumming, GA fee schedule · outpatient	1	$50k	$50k	—	—	—	$50k – $50k
20	Northside Hospital, Inc. Duluth, GA fee schedule · outpatient	1	$50k	$50k	—	—	—	$50k – $50k
21	Northside Hospital, Inc. Canton, GA fee schedule · outpatient	1	$50k	$50k	—	—	—	$50k – $50k
22	OUR LADY OF LOURDES MEMORIAL HOSPITAL INC. Doing Business As: LOURDES Binghamton, NY facility · other · outpatient	1	$150	$150	—	—	—	$150 – $150
23	Overlook Medical Center Summit, NJ other · outpatient	2	$669	$669	—	—	—	$669 – $669
24	Presbyterian Medical Center of the University of Pennsylvania Health System D/B/A Penn Presbyterian Medical Center Philadelphia, PA facility · fee schedule · outpatient	1	$1.8k	$1.8k	—	—	—	$1.8k – $1.8k
25	St Anthony Community Hospital Warwick, NY facility · fee schedule · outpatient	1	$50k	$50k	—	—	—	$50k – $50k