Dermagraft skin substitute

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, DERMAGRAFT SKIN

Payers reporting HCPCS Q4106

Payer pricing summary

Low

$27

Average

$698

Median

$443

High

$4.5k

Payer rate distribution

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#
1	UnitedHealthcare fee schedule · outpatient · +22 other terms	258	$76	$293	$628	215%	—	$1 – $4.8k
2	Cigna fee schedule · outpatient · +18 other terms	241	$84	$255	$811	318%	—	$15 – $6.6k
3	Blue Cross Blue Shield fee schedule · outpatient · +23 other terms	141	$132	$510	$1.4k	281%	—	$1 – $11.6k
4	Humana fee schedule · outpatient · +21 other terms	100	$104	$328	$509	155%	—	$1 – $2.7k
5	Aetna fee schedule · outpatient · +22 other terms	96	$51	$295	$1.1k	360%	—	$14 – $6.8k
6	MultiPlan fee schedule · inpatient · +14 other terms	59	$1.6k	$2.1k	$2.0k	96%	—	$57 – $7.4k
7	Anthem fee schedule · outpatient · +16 other terms	42	$53	$129	$495	384%	—	$15 – $5.8k
8	Molina fee schedule · outpatient · +19 other terms	31	$31	$33	$16	49%	—	$1 – $77
9	Bcbs Tx fee schedule · outpatient · +2 other terms	30	$159	$145	$48	33%	—	$59 – $250
10	Medica fee schedule · outpatient · +12 other terms	29	$356	$962	$1.2k	126%	—	$33 – $3.6k
11	Medcost percent of total billed charges · bothfrom % of charges · +5 other terms	26	$55	$6	$26	425%	—	$0 – $233
12	Caresource fee schedule · outpatient · +9 other terms	20	$238	$222	$229	103%	—	$1 – $524
13	Kaiser fee schedule · outpatient · +10 other terms	19	$1.9k	$1.7k	$2.2k	133%	—	$16 – $6.3k
14	Medicaid fee schedule · both · +4 other terms	19	$41	$111	$597	539%	—	$38 – $5.6k
15	Regence professional · fee schedule · outpatient · +5 other terms	19	$16	$16	—	—	—	$16 – $16
16	Healthpartners fee schedule · outpatient · +5 other terms	18	$54	$54	$1	2%	—	$52 – $55
17	First Health fee schedule · outpatient · +14 other terms	16	$3.3k	$3.3k	$2.7k	82%	—	$71 – $7.2k
18	Superior Healthplan percent of total billed charges · outpatientfrom % of charges	15	$183	$299	$778	260%	—	$3 – $4.2k
19	WellCare fee schedule · both · +12 other terms	15	$34	$34	$0	1%	—	$33 – $34
20	Bcbs La fee schedule · outpatient · +3 other terms	14	$31	$32	$2	6%	—	$31 – $35
21	Phcs fee schedule · inpatient · +10 other terms	14	$1.3k	$1.6k	$1.2k	77%	—	$50 – $3.7k
22	Amerihealth Caritas fee schedule · both · +7 other terms	12	$34	$34	—	—	—	$34 – $34
23	Bcbs Mn fee schedule · outpatient · +3 other terms	12	$38	$30	$20	67%	—	$1 – $48
24	Bcbs Nc percent of total billed charges · outpatientfrom % of charges · +1 other terms	12	$43	$42	$3	7%	—	$27 – $44
25	Beechstreet percent of total billed charges · inpatientfrom % of charges · +1 other terms	12	$127	$128	$4	3%	—	$123 – $136

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