Skin graft substitute material

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

TISSUE DERMAL MEMODERM (50SQ CM)5X10CM NON-MESHED EXTRA THICK 19800

Payers reporting HCPCS Q4126

Payer pricing summary

Low

$66

Average

$1.8k

Median

$858

High

$12.6k

Payer rate distribution

Filter by billing methodology

Filter by billing class

#
1	UnitedHealthcare fee schedule · outpatient · +18 other terms	469	$164	$275	$894	325%	—	$1 – $11.7k
2	Cigna fee schedule · outpatient · +18 other terms	323	$131	$1.0k	$3.3k	320%	—	$40 – $33.0k
3	Aetna fee schedule · outpatient · +20 other terms	261	$129	$505	$1.6k	323%	—	$61 – $11.6k
4	Humana fee schedule · outpatient · +15 other terms	189	$116	$385	$1.2k	306%	—	$1 – $8.3k
5	Blue Cross Blue Shield fee schedule · outpatient · +17 other terms	174	$131	$582	$2.0k	342%	—	$0 – $19.5k
6	Molina fee schedule · outpatient · +16 other terms	96	$146	$179	$298	167%	—	$1 – $3.4k
7	Caresource fee schedule · outpatient · +8 other terms	63	$101	$152	$167	110%	—	$1 – $524
8	Kaiser fee schedule · outpatient · +10 other terms	59	$277	$2.0k	$3.5k	175%	—	$60 – $16.6k
9	Anthem fee schedule · outpatient · +12 other terms	57	$208	$784	$2.4k	303%	—	$48 – $29.4k
10	WellCare fee schedule · outpatient · +12 other terms	51	$135	$183	$385	210%	—	$63 – $3.0k
11	Ambetter facility · fee schedule · outpatient · +10 other terms	48	$212	$255	$32	13%	—	$60 – $269
12	Devoted fee schedule · outpatient · +4 other terms	35	$125	$125	$8	6%	—	$116 – $139
13	Optum fee schedule · outpatient · +8 other terms	32	$125	$173	$91	53%	—	$113 – $459
14	Baylor Scott White Health Plan facility · fee schedule · outpatient · +2 other terms	25	$158	$158	$31	20%	—	$119 – $207
15	Bcbs La fee schedule · outpatient · +2 other terms	24	$96	$95	$3	3%	—	$88 – $96
16	Superior Healthplan facility · fee schedule · outpatient · +3 other terms	23	$131	$128	$8	6%	—	$45 – $131
17	MultiPlan fee schedule · inpatient · +12 other terms	22	$10.6k	$10.9k	$6.7k	61%	—	$2.1k – $35.7k
18	Regence professional · fee schedule · outpatient · +4 other terms	21	$88	$91	$13	15%	—	$88 – $153
19	Aetna Better Health other · outpatient · +6 other terms	19	$1.4k	$1.9k	$1.6k	86%	—	$871 – $8.2k
20	Amerihealth Caritas other · outpatient · +3 other terms	19	$1.4k	$1.9k	$1.6k	86%	—	$871 – $8.2k
21	Healthpartners fee schedule · outpatient · +3 other terms	19	$71	$73	$10	14%	—	$69 – $131
22	Oscar facility · fee schedule · outpatient · +9 other terms	19	$182	$160	$59	37%	—	$74 – $234
23	Tricare facility · fee schedule · outpatient · +5 other terms	19	$127	$130	$9	7%	—	$109 – $149
24	Medical Mutual facility · fee schedule · outpatient · +4 other terms	18	$134	$158	$69	44%	—	$64 – $468
25	Medicare fee schedule · outpatient · +5 other terms	18	$125	$125	—	—	—	$125 – $125

Page 1 of 3 · 57 payers