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 ac, 1 cm

Payers reporting HCPCS Q4141

Payer pricing summary

Low

$25

Average

$196

Median

$125

High

$1.2k

Payer rate distribution

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#
1	UnitedHealthcare fee schedule · outpatient · +9 other terms	432	$148	$158	$102	65%	—	$1 – $613
2	Cigna fee schedule · outpatient · +10 other terms	292	$121	$179	$139	77%	—	$0 – $644
3	Aetna fee schedule · outpatient · +11 other terms	241	$127	$139	$71	51%	—	$38 – $515
4	Humana fee schedule · outpatient · +10 other terms	188	$111	$93	$51	55%	—	$1 – $360
5	Blue Cross Blue Shield fee schedule · outpatient · +7 other terms	145	$127	$150	$102	68%	—	$1 – $582
6	Molina fee schedule · outpatient · +9 other terms	88	$178	$211	$336	159%	—	$1 – $3.4k
7	Caresource fee schedule · outpatient · +3 other terms	62	$65	$85	$55	65%	—	$1 – $213
8	Anthem facility · fee schedule · outpatient · +7 other terms	55	$151	$157	$151	96%	—	$37 – $1.2k
9	WellCare fee schedule · outpatient · +6 other terms	51	$135	$130	$30	23%	—	$38 – $171
10	Ambetter fee schedule · outpatient · +4 other terms	42	$234	$218	$70	32%	—	$61 – $351
11	Kaiser fee schedule · outpatient · +6 other terms	42	$207	$266	$182	68%	—	$80 – $1000
12	Devoted fee schedule · outpatient · +3 other terms	35	$125	$125	$8	6%	—	$116 – $139
13	Optum fee schedule · outpatient · +2 other terms	32	$125	$173	$91	53%	—	$113 – $459
14	Healthpartners fee schedule · outpatient · +1 other terms	19	$45	$48	$14	29%	—	$44 – $131
15	Oscar facility · fee schedule · outpatient · +1 other terms	19	$182	$162	$57	35%	—	$80 – $234
16	Medical Mutual facility · fee schedule · outpatient · +3 other terms	18	$139	$166	$71	43%	—	$64 – $468
17	Medicare fee schedule · outpatient · +2 other terms	18	$125	$125	—	—	—	$125 – $125
18	Highmark fee schedule · outpatient · +4 other terms	16	$47	$106	$344	324%	—	$44 – $3.4k
19	Wellmark fee schedule · both · +1 other terms	14	$38	$39	$4	11%	—	$38 – $65
20	Bcbs Mn fee schedule · outpatient · +3 other terms	12	$19	$17	$12	72%	—	$1 – $38
21	Aetna Better Health fee schedule · outpatient · +3 other terms	11	$43	$45	$3	7%	—	$43 – $49
22	Bcbs Nj fee schedule · outpatient	11	$53	$54	$30	56%	—	$38 – $111
23	Tricare fee schedule · outpatient · +1 other terms	11	$113	$118	$10	8%	—	$113 – $148
24	Medica fee schedule · outpatient · +4 other terms	10	$80	$81	$20	25%	—	$49 – $103
25	Regence fee schedule · outpatient · +4 other terms	10	$146	$146	$4	3%	—	$140 – $156

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