Alloskin acellular dermal matrix, 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

Alloskin

Payers reporting HCPCS Q4123

Payer pricing summary

Low

Average

$209

Median

$125

High

$2.0k

Payer rate distribution

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#
1	UnitedHealthcare fee schedule · outpatient · +12 other terms	433	$179	$178	$96	54%	—	$1 – $613
2	Cigna fee schedule · outpatient · +10 other terms	269	$134	$204	$144	71%	—	$26 – $644
3	Aetna fee schedule · outpatient · +14 other terms	246	$132	$148	$87	59%	—	$23 – $903
4	Humana fee schedule · outpatient · +13 other terms	195	$116	$342	$1.1k	330%	—	$1 – $8.3k
5	Blue Cross Blue Shield fee schedule · outpatient · +8 other terms	156	$125	$139	$91	66%	—	$0 – $580
6	Molina fee schedule · outpatient · +8 other terms	60	$192	$243	$383	158%	—	$1 – $3.4k
7	Anthem facility · fee schedule · outpatient · +6 other terms	59	$132	$161	$144	89%	—	$42 – $1.2k
8	WellCare fee schedule · outpatient · +7 other terms	51	$135	$133	$23	17%	—	$72 – $171
9	Caresource fee schedule · outpatient · +3 other terms	50	$79	$90	$54	60%	—	$1 – $213
10	Kaiser fee schedule · outpatient · +4 other terms	42	$207	$267	$181	68%	—	$125 – $1000
11	Ambetter fee schedule · outpatient · +5 other terms	39	$234	$231	$58	25%	—	$67 – $351
12	Devoted fee schedule · outpatient · +3 other terms	35	$125	$125	$8	6%	—	$116 – $139
13	Optum fee schedule · outpatient · +3 other terms	32	$125	$173	$91	53%	—	$113 – $459
14	Regence professional · fee schedule · outpatient · +4 other terms	20	$23	$30	$28	93%	—	$23 – $153
15	Healthpartners fee schedule · outpatient · +1 other terms	19	$45	$47	$14	30%	—	$44 – $131
16	Oscar facility · fee schedule · outpatient · +1 other terms	19	$182	$164	$53	32%	—	$89 – $234
17	Medical Mutual facility · fee schedule · outpatient · +3 other terms	18	$144	$178	$76	43%	—	$64 – $468
18	Medicare fee schedule · outpatient · +3 other terms	18	$125	$125	—	—	—	$125 – $125
19	Highmark fee schedule · outpatient · +4 other terms	16	$89	$143	$338	236%	—	$83 – $3.4k
20	Wellmark fee schedule · both · +2 other terms	14	$67	$66	$4	6%	—	$44 – $72
21	Bcbs Mn fee schedule · outpatient · +3 other terms	12	$32	$29	$22	77%	—	$1 – $72
22	Aetna Better Health fee schedule · outpatient · +4 other terms	11	$86	$72	$19	26%	—	$47 – $86
23	Bcbs Nj fee schedule · outpatient	11	$68	$68	$3	5%	—	$66 – $74
24	Tricare fee schedule · outpatient · +1 other terms	11	$113	$118	$10	8%	—	$113 – $148
25	Medica fee schedule · outpatient · +5 other terms	10	$76	$77	$19	25%	—	$46 – $99

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