Grafix Prime wound care tissue 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

HC GRAFIX PRIME PER 1SQ CM Q4133 (HIGH)

Payers reporting HCPCS Q4133

Payer pricing summary

Low

$110

Average

$1.3k

Median

$961

High

$7.4k

Payer rate distribution

Filter by billing methodology

Filter by billing class

#
1	Blue Cross Blue Shield fee schedule · outpatient · +29 other terms	237	$204	$801	$1.5k	191%	97–970	$0 – $15.0k
2	Anthem fee schedule · outpatient · +19 other terms	108	$181	$363	$1.5k	409%	11–110	$2 – $38.4k
3	UnitedHealthcare fee schedule · outpatient · +25 other terms	568	$210	$624	$2.0k	316%	—	$1 – $40.7k
4	Cigna fee schedule · outpatient · +25 other terms	386	$229	$1.3k	$3.8k	305%	—	$0 – $43.1k
5	Aetna fee schedule · outpatient · +26 other terms	307	$147	$1.6k	$4.0k	252%	—	$1 – $43.7k
6	Humana fee schedule · outpatient · +24 other terms	261	$136	$648	$1.3k	193%	—	$1 – $10.5k
7	Molina fee schedule · outpatient · +23 other terms	110	$194	$389	$1.1k	291%	—	$1 – $17.2k
8	MultiPlan fee schedule · outpatient · +17 other terms	77	$6.1k	$5.2k	$7.8k	151%	—	$136 – $46.6k
9	Kaiser fee schedule · outpatient · +20 other terms	75	$277	$2.7k	$5.5k	204%	—	$99 – $39.8k
10	Caresource fee schedule · outpatient · +12 other terms	72	$138	$275	$592	216%	—	$1 – $4.8k
11	WellCare fee schedule · outpatient · +18 other terms	58	$136	$180	$277	154%	—	$25 – $2.7k
12	Ambetter facility · fee schedule · outpatient · +16 other terms	57	$212	$241	$328	136%	—	$129 – $6.3k
13	Devoted facility · fee schedule · outpatient · +12 other terms	43	$118	$122	$9	8%	—	$112 – $162
14	Highmark facility · fee schedule · outpatient · +13 other terms	40	$146	$180	$129	72%	—	$85 – $954
15	Tricare facility · fee schedule · outpatient · +14 other terms	39	$127	$312	$757	242%	—	$104 – $4.4k
16	Medica fee schedule · outpatient · +17 other terms	33	$547	$1.3k	$1.6k	128%	—	$100 – $13.7k
17	First Health fee schedule · outpatient · +14 other terms	31	$5.4k	$8.1k	$9.4k	116%	—	$167 – $45.4k
18	Oscar facility · fee schedule · outpatient · +13 other terms	30	$172	$212	$582	275%	—	$143 – $6.4k
19	Medicare other · both · +12 other terms	26	$128	$139	$11	8%	—	$116 – $151
20	Optum fee schedule · outpatient · +13 other terms	26	$130	$938	$1.6k	165%	—	$100 – $9.0k
21	Baylor Scott White Health Plan facility · fee schedule · outpatient · +2 other terms	25	$158	$158	$31	20%	—	$119 – $207
22	Superior Healthplan facility · fee schedule · outpatient · +4 other terms	22	$131	$129	$3	2%	—	$108 – $134
23	Medicaid fee schedule · outpatient · +8 other terms	21	$183	$311	$721	232%	—	$1 – $4.0k
24	Regence professional · fee schedule · outpatient · +15 other terms	21	$134	$135	$4	3%	—	$134 – $153
25	Healthpartners fee schedule · outpatient · +10 other terms	20	$166	$167	$11	7%	—	$131 – $208

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