Human dermal matrix graft

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 DERMAL 0.8 TO 1.7MMX8 20CM PLIABLE FOLDING HYDRATED THICK FLEXHD ACELLULAR DERMIS IMPLANTABLE

Payers reporting HCPCS Q4128

Payer pricing summary

Low

Average

$2.5k

Median

$1.6k

High

$29.5k

Payer rate distribution

Filter by billing methodology

Filter by billing class

#
1	Blue Cross Blue Shield fee schedule · outpatient · +27 other terms	191	$128	$1.7k	$6.0k	347%	53–530	$0 – $51.8k
2	UnitedHealthcare fee schedule · outpatient · +24 other terms	508	$140	$1.3k	$4.8k	381%	—	$1 – $60.4k
3	Cigna fee schedule · outpatient · +21 other terms	363	$68	$1.9k	$7.1k	366%	—	$22 – $72.3k
4	Aetna fee schedule · outpatient · +22 other terms	283	$127	$2.1k	$5.5k	263%	—	$1 – $54.4k
5	Humana fee schedule · outpatient · +21 other terms	196	$116	$834	$4.5k	537%	—	$1 – $60.4k
6	Molina fee schedule · outpatient · +19 other terms	103	$146	$432	$2.5k	573%	—	$1 – $36.9k
7	Anthem fee schedule · outpatient · +19 other terms	74	$277	$8.5k	$14.7k	173%	—	$2 – $82.1k
8	Kaiser fee schedule · outpatient · +17 other terms	69	$290	$6.1k	$10.9k	177%	—	$27 – $63.3k
9	Caresource fee schedule · outpatient · +13 other terms	65	$52	$243	$227	94%	—	$1 – $524
10	Ambetter facility · fee schedule · outpatient · +14 other terms	64	$214	$326	$900	276%	—	$31 – $11.4k
11	WellCare fee schedule · outpatient · +16 other terms	56	$131	$141	$70	50%	—	$24 – $992
12	MultiPlan fee schedule · inpatient · +16 other terms	49	$15.8k	$18.9k	$19.7k	104%	—	$52 – $112.8k
13	Devoted facility · fee schedule · outpatient · +12 other terms	39	$118	$121	$6	5%	—	$113 – $143
14	Optum fee schedule · outpatient · +11 other terms	35	$125	$2.1k	$4.1k	198%	—	$60 – $22.0k
15	Tricare facility · fee schedule · outpatient · +10 other terms	33	$127	$721	$2.8k	383%	—	$109 – $21.6k
16	Medcost percent of total billed charges · bothfrom % of charges · +5 other terms	31	$12.9k	$1.5k	$8.3k	558%	—	$0 – $171.3k
17	First Health fee schedule · outpatient · +14 other terms	27	$17.5k	$17.3k	$16.4k	94%	—	$49 – $72.5k
18	Amerihealth Caritas other · outpatient · +8 other terms	25	$3.5k	$4.3k	$5.9k	137%	—	$96 – $48.2k
19	Baylor Scott White Health Plan facility · fee schedule · outpatient · +2 other terms	25	$158	$158	$31	20%	—	$119 – $207
20	Highmark facility · fee schedule · outpatient · +11 other terms	24	$117	$121	$77	63%	—	$12 – $401
21	Superior Healthplan facility · fee schedule · outpatient · +4 other terms	23	$131	$129	$7	5%	—	$23 – $131
22	Oscar facility · fee schedule · outpatient · +10 other terms	22	$182	$319	$1.3k	399%	—	$38 – $11.5k
23	Regence professional · fee schedule · outpatient · +8 other terms	21	$31	$36	$25	70%	—	$31 – $153
24	Bcbs La fee schedule · outpatient · +2 other terms	20	$34	$34	$0	1%	—	$27 – $34
25	Beechstreet percent of total billed charges · outpatientfrom % of charges · +3 other terms	20	$1.8k	$4.7k	$12.3k	265%	—	$35 – $82.4k

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