Ez-Derm 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

EZderm

Payers reporting HCPCS Q4136

Payer pricing summary

Low

Average

$143

Median

$121

High

$607

Payer rate distribution

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#
1	UnitedHealthcare fee schedule · outpatient · +20 other terms	260	$210	$226	$133	59%	—	$0 – $1.2k
2	Aetna fee schedule · outpatient · +19 other terms	121	$124	$91	$72	80%	—	$1 – $444
3	Humana fee schedule · outpatient · +18 other terms	75	$125	$118	$35	29%	—	$1 – $171
4	Blue Cross Blue Shield facility · fee schedule · outpatient · +23 other terms	69	$130	$227	$350	154%	—	$0 – $2.1k
5	Cigna fee schedule · outpatient · +19 other terms	61	$134	$227	$216	95%	—	$5 – $1.1k
6	WellCare fee schedule · outpatient · +11 other terms	41	$136	$138	$14	10%	—	$119 – $171
7	Molina facility · fee schedule · outpatient · +13 other terms	39	$118	$129	$49	38%	—	$65 – $319
8	Anthem facility · fee schedule · outpatient · +13 other terms	37	$118	$191	$184	96%	—	$0 – $1.2k
9	Kaiser fee schedule · outpatient · +11 other terms	25	$125	$263	$224	85%	—	$52 – $1000
10	Devoted fee schedule · outpatient · +6 other terms	23	$125	$122	$5	4%	—	$116 – $139
11	Optum fee schedule · outpatient · +4 other terms	22	$125	$151	$98	65%	—	$113 – $459
12	Ambetter fee schedule · outpatient · +6 other terms	20	$272	$267	$41	15%	—	$218 – $351
13	Medicare fee schedule · outpatient · +4 other terms	18	$125	$125	—	—	—	$125 – $125
14	Caresource fee schedule · outpatient · +6 other terms	16	$194	$182	$220	121%	—	$1 – $524
15	Highmark fee schedule · outpatient · +7 other terms	16	$109	$163	$342	210%	—	$102 – $3.4k
16	Tricare fee schedule · outpatient · +3 other terms	15	$121	$119	$6	5%	—	$113 – $127
17	Medcost facility · percent of total billed charges · bothfrom % of charges · +3 other terms	14	$3	$3	$1	17%	—	$3 – $4
18	Medical Mutual facility · fee schedule · outpatient · +2 other terms	13	$118	$123	$13	10%	—	$118 – $167
19	Oscar facility · fee schedule · outpatient · +7 other terms	11	$175	$177	$3	2%	—	$175 – $182
20	Baylor Scott White Health Plan facility · fee schedule · outpatient · +2 other terms	10	$158	$158	$31	20%	—	$119 – $206
21	Regence fee schedule · outpatient · +8 other terms	10	$146	$146	$4	3%	—	$140 – $156
22	Bcbs Mn fee schedule · both · +2 other terms	8	$5	$5	$0	1%	—	$5 – $6
23	Superior Healthplan facility · fee schedule · outpatient · +1 other terms	8	$125	$125	—	—	—	$125 – $125
24	Aetna Better Health fee schedule · inpatient · +5 other terms	7	$1	$1	—	—	—	$1 – $1
25	Excellus fee schedule · outpatient · +5 other terms	6	$174	$155	$110	71%	—	$6 – $351

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