Skin substitute graft (extracellular 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

Architect ecm px fx 1 sq cm

Payers reporting HCPCS Q4147

Payer pricing summary

Low

$47

Average

$359

Median

$189

High

$4.0k

Payer rate distribution

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Filter by billing class

#
1	UnitedHealthcare fee schedule · outpatient · +9 other terms	417	$273	$978	$1.5k	152%	—	$1 – $9.9k
2	Cigna fee schedule · outpatient · +9 other terms	248	$135	$200	$120	60%	—	$0 – $910
3	Aetna fee schedule · outpatient · +12 other terms	222	$127	$141	$75	53%	—	$46 – $515
4	Blue Cross Blue Shield fee schedule · outpatient · +7 other terms	119	$136	$297	$350	118%	—	$1 – $1.4k
5	Humana fee schedule · outpatient · +9 other terms	98	$127	$192	$220	114%	—	$1 – $1.3k
6	Molina fee schedule · outpatient · +8 other terms	57	$193	$298	$445	149%	—	$1 – $3.4k
7	WellCare fee schedule · outpatient · +5 other terms	45	$135	$138	$14	10%	—	$115 – $171
8	Kaiser fee schedule · outpatient · +3 other terms	40	$207	$263	$185	70%	—	$102 – $1000
9	Anthem facility · fee schedule · outpatient · +5 other terms	39	$118	$225	$188	84%	—	$48 – $1.2k
10	Ambetter fee schedule · outpatient · +3 other terms	37	$234	$251	$55	22%	—	$162 – $398
11	Devoted fee schedule · outpatient · +3 other terms	32	$125	$124	$7	6%	—	$116 – $136
12	Optum fee schedule · outpatient · +2 other terms	32	$125	$173	$91	53%	—	$113 – $459
13	Caresource fee schedule · outpatient · +2 other terms	25	$100	$93	$66	71%	—	$1 – $213
14	Healthpartners fee schedule · outpatient · +1 other terms	19	$176	$175	$8	5%	—	$131 – $180
15	Oscar facility · fee schedule · outpatient · +2 other terms	19	$182	$196	$25	13%	—	$175 – $234
16	Medical Mutual facility · fee schedule · outpatient · +3 other terms	18	$266	$310	$164	53%	—	$64 – $628
17	Medicare fee schedule · outpatient · +1 other terms	18	$125	$125	—	—	—	$125 – $125
18	Highmark fee schedule · outpatient · +4 other terms	16	$182	$223	$327	147%	—	$49 – $3.4k
19	Wellmark fee schedule · both · +2 other terms	13	$1.6k	$1.5k	$225	15%	—	$167 – $1.6k
20	Bcbs Nj fee schedule · outpatient	12	$47	$47	—	—	—	$47 – $47
21	Aetna Better Health fee schedule · outpatient · +2 other terms	11	$152	$163	$15	9%	—	$152 – $182
22	Tricare fee schedule · outpatient · +1 other terms	11	$113	$118	$10	8%	—	$113 – $148
23	Medica fee schedule · outpatient · +4 other terms	10	$299	$301	$75	25%	—	$181 – $386
24	Regence fee schedule · outpatient · +4 other terms	10	$146	$146	$4	3%	—	$140 – $156
25	Bcbs Mn fee schedule · both · +2 other terms	8	$149	$148	$1	1%	—	$147 – $150

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