Gammagraft tissue graft, per square centimeter

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

Gammagraft

Payers reporting HCPCS Q4111

Payer pricing summary

Low

Average

$107

Median

$103

High

$418

Payer rate distribution

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#
1	UnitedHealthcare fee schedule · outpatient · +15 other terms	436	$130	$134	$123	92%	—	$1 – $613
2	Cigna fee schedule · outpatient · +15 other terms	293	$19	$52	$76	147%	—	$6 – $644
3	Aetna fee schedule · outpatient · +16 other terms	258	$124	$105	$77	73%	—	$7 – $515
4	Humana fee schedule · outpatient · +15 other terms	230	$30	$66	$58	88%	—	$1 – $360
5	Blue Cross Blue Shield fee schedule · outpatient · +11 other terms	228	$74	$76	$95	124%	—	$0 – $582
6	Molina fee schedule · outpatient · +9 other terms	83	$165	$204	$356	174%	—	$1 – $3.4k
7	Caresource fee schedule · outpatient · +4 other terms	62	$48	$66	$63	96%	—	$1 – $213
8	Anthem facility · fee schedule · outpatient · +9 other terms	58	$122	$116	$152	132%	—	$7 – $1.2k
9	WellCare fee schedule · outpatient · +9 other terms	50	$135	$123	$44	35%	—	$8 – $171
10	Ambetter fee schedule · outpatient · +5 other terms	42	$234	$207	$92	45%	—	$7 – $351
11	Kaiser fee schedule · outpatient · +5 other terms	42	$207	$265	$183	69%	—	$15 – $1000
12	Devoted fee schedule · outpatient · +3 other terms	36	$125	$125	$8	6%	—	$116 – $139
13	Optum fee schedule · outpatient · +2 other terms	32	$125	$173	$91	53%	—	$113 – $459
14	Bcbs Tx fee schedule · outpatient · +1 other terms	30	$34	$31	$10	33%	—	$12 – $53
15	Regence professional · fee schedule · outpatient · +4 other terms	21	$7	$14	$30	222%	—	$7 – $153
16	Healthpartners fee schedule · outpatient · +1 other terms	19	$9	$12	$20	165%	—	$9 – $131
17	Oscar facility · fee schedule · outpatient · +2 other terms	19	$182	$140	$88	63%	—	$9 – $234
18	Medical Mutual facility · fee schedule · outpatient · +3 other terms	18	$60	$68	$86	126%	—	$10 – $468
19	Medicare fee schedule · outpatient · +3 other terms	18	$125	$125	—	—	—	$125 – $125
20	Highmark fee schedule · outpatient · +7 other terms	16	$9	$70	$350	498%	—	$8 – $3.4k
21	Bcbs Mn fee schedule · outpatient · +3 other terms	12	$8	$4	$4	92%	—	$1 – $10
22	Aetna Better Health fee schedule · outpatient · +5 other terms	11	$7	$8	$1	11%	—	$7 – $9
23	Bcbs Nj fee schedule · outpatient	11	$8	$8	$0	5%	—	$7 – $8
24	Tricare fee schedule · outpatient · +2 other terms	11	$113	$118	$10	8%	—	$113 – $148
25	Medica fee schedule · outpatient · +6 other terms	10	$15	$15	$4	25%	—	$9 – $19

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