Amniotic tissue wound graft, 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-sonnet-5-5
Provider: anthropic
API: message_batches
Reasoning effort: model default
Max output tokens: 4096
Prompt version (hash): 444523875572
Generated: October 20, 2026

Original text from hospital filings

GRAFT SKIN 8X3CM AMNIOBAND 24SQ CM ALLOGRAFT

Payers reporting HCPCS Q4151

Payer pricing summary

Low

$78

Average

$1.3k

Median

$479

High

$9.8k

Payer rate distribution

Filter by billing methodology

Filter by billing class

#
1	UnitedHealthcare fee schedule · outpatient · +18 other terms	459	$210	$589	$2.8k	476%	—	$1 – $52.4k
2	Cigna fee schedule · outpatient · +19 other terms	318	$219	$995	$3.4k	342%	—	$0 – $40.9k
3	Aetna fee schedule · outpatient · +20 other terms	273	$145	$2.4k	$7.4k	313%	—	$1 – $56.2k
4	Humana fee schedule · outpatient · +16 other terms	180	$132	$279	$1.0k	370%	—	$1 – $12.3k
5	Blue Cross Blue Shield facility · fee schedule · outpatient · +21 other terms	174	$137	$165	$116	70%	—	$1 – $1.2k
6	Molina fee schedule · outpatient · +16 other terms	92	$200	$622	$2.0k	327%	—	$1 – $22.1k
7	Caresource fee schedule · outpatient · +10 other terms	62	$136	$133	$71	53%	—	$48 – $270
8	Anthem facility · fee schedule · outpatient · +16 other terms	59	$162	$246	$207	84%	—	$48 – $1.2k
9	Ambetter facility · fee schedule · outpatient · +11 other terms	57	$212	$248	$41	17%	—	$135 – $331
10	Kaiser fee schedule · outpatient · +12 other terms	52	$261	$1.8k	$4.0k	226%	—	$1 – $38.3k
11	WellCare fee schedule · outpatient · +13 other terms	52	$136	$144	$11	7%	—	$57 – $171
12	Optum fee schedule · outpatient · +11 other terms	36	$125	$1.0k	$2.3k	225%	—	$1 – $11.6k
13	Devoted fee schedule · outpatient · +9 other terms	35	$125	$126	$7	6%	—	$116 – $139
14	MultiPlan fee schedule · outpatient · +14 other terms	26	$5.8k	$6.1k	$11.3k	186%	—	$1 – $57.5k
15	Amerihealth Caritas other · outpatient · +7 other terms	25	$1.6k	$1.7k	$1.8k	102%	—	$64 – $11.7k
16	Baylor Scott White Health Plan facility · fee schedule · outpatient · +2 other terms	25	$158	$158	$31	20%	—	$119 – $207
17	Bcbs La fee schedule · outpatient · +2 other terms	25	$154	$154	$3	2%	—	$137 – $154
18	Highmark facility · fee schedule · outpatient · +11 other terms	25	$132	$180	$138	77%	—	$79 – $954
19	Superior Healthplan facility · fee schedule · outpatient · +3 other terms	22	$131	$129	$4	3%	—	$125 – $153
20	Tricare facility · fee schedule · outpatient · +9 other terms	22	$127	$199	$536	269%	—	$109 – $4.9k
21	Oscar facility · fee schedule · outpatient · +9 other terms	21	$182	$182	$27	15%	—	$143 – $234
22	Regence professional · fee schedule · outpatient · +8 other terms	21	$121	$123	$8	6%	—	$121 – $153
23	Medcost percent of total billed charges · outpatientfrom % of charges · +5 other terms	20	$278	$558	$287	51%	—	$53 – $1.5k
24	Aetna Better Health other · outpatient · +8 other terms	19	$1.3k	$1.7k	$1.8k	110%	—	$64 – $11.7k
25	Healthpartners fee schedule · outpatient · +2 other terms	19	$171	$170	$7	4%	—	$131 – $175

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