Theraskin skin substitute, 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

GRAFT THERASKIN CROPRESERVED SKIN 3X6IN - 116 CM-COST PER SQ CM

Payers reporting HCPCS Q4121

Payer pricing summary

Low

Average

$807

Median

$519

High

$5.1k

Payer rate distribution

Filter by billing methodology

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#
1	UnitedHealthcare fee schedule · outpatient · +26 other terms	512	$148	$247	$603	244%	—	$1 – $10.5k
2	Cigna fee schedule · outpatient · +26 other terms	342	$108	$166	$309	185%	—	$17 – $4.7k
3	Aetna fee schedule · outpatient · +27 other terms	301	$127	$292	$710	244%	—	$1 – $4.9k
4	Blue Cross Blue Shield fee schedule · outpatient · +29 other terms	271	$129	$205	$404	197%	—	$1 – $3.6k
5	Humana fee schedule · outpatient · +25 other terms	267	$121	$176	$335	190%	—	$1 – $4.4k
6	Molina fee schedule · outpatient · +21 other terms	94	$148	$237	$650	274%	—	$1 – $6.5k
7	Anthem fee schedule · outpatient · +19 other terms	79	$62	$125	$749	597%	—	$2 – $14.3k
8	Caresource fee schedule · outpatient · +12 other terms	77	$82	$321	$241	75%	—	$1 – $2.0k
9	WellCare fee schedule · outpatient · +16 other terms	62	$127	$122	$98	81%	—	$11 – $1.1k
10	Ambetter facility · fee schedule · outpatient · +14 other terms	55	$217	$239	$36	15%	—	$48 – $331
11	Kaiser fee schedule · outpatient · +15 other terms	47	$207	$452	$1.3k	282%	—	$60 – $10.1k
12	Highmark facility · fee schedule · outpatient · +13 other terms	44	$64	$82	$60	74%	—	$17 – $401
13	MultiPlan fee schedule · outpatient · +18 other terms	42	$2.6k	$1.7k	$2.5k	150%	—	$56 – $13.2k
14	Devoted facility · fee schedule · outpatient · +9 other terms	40	$118	$121	$7	6%	—	$112 – $143
15	Optum fee schedule · outpatient · +15 other terms	38	$125	$140	$89	64%	—	$46 – $459
16	Tricare facility · fee schedule · outpatient · +10 other terms	29	$127	$143	$87	61%	—	$91 – $864
17	Medica fee schedule · outpatient · +16 other terms	28	$638	$476	$897	188%	—	$27 – $2.9k
18	Oscar facility · fee schedule · outpatient · +14 other terms	28	$118	$144	$57	40%	—	$56 – $234
19	Bcbs Tx fee schedule · outpatient · +3 other terms	27	$202	$189	$56	30%	—	$74 – $311
20	Amerihealth Caritas other · outpatient · +10 other terms	25	$1.6k	$1.6k	$1.7k	101%	—	$16 – $12.4k
21	Baylor Scott White Health Plan facility · fee schedule · outpatient · +2 other terms	25	$158	$158	$31	20%	—	$119 – $207
22	Bcbs La fee schedule · outpatient · +2 other terms	25	$54	$54	$1	2%	—	$48 – $57
23	Medicare fee schedule · outpatient · +10 other terms	24	$125	$137	$77	56%	—	$123 – $789
24	Phcs fee schedule · outpatient · +11 other terms	21	$2.3k	$918	$1.3k	138%	—	$87 – $4.5k
25	Regence professional · fee schedule · outpatient · +6 other terms	21	$44	$49	$23	46%	—	$44 – $153

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