Dermapure skin graft material, 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

4X6CM DERMAPURE ALLOGRAFT

Payers reporting HCPCS Q4152

Payer pricing summary

Low

$38

Average

$743

Median

$235

High

$3.8k

Payer rate distribution

Filter by billing methodology

Filter by billing class

#
1	UnitedHealthcare fee schedule · outpatient · +20 other terms	457	$142	$375	$1.6k	436%	—	$38 – $22.0k
2	Cigna fee schedule · outpatient · +17 other terms	314	$105	$671	$2.4k	351%	—	$0 – $24.8k
3	Aetna fee schedule · outpatient · +21 other terms	275	$127	$1.7k	$4.3k	255%	—	$44 – $23.6k
4	Humana fee schedule · outpatient · +16 other terms	194	$116	$486	$1.9k	385%	—	$41 – $14.9k
5	Blue Cross Blue Shield fee schedule · outpatient · +18 other terms	166	$128	$571	$1.5k	269%	—	$1 – $11.5k
6	Molina fee schedule · outpatient · +15 other terms	90	$191	$628	$1.4k	217%	—	$45 – $9.3k
7	Caresource fee schedule · outpatient · +12 other terms	62	$88	$92	$59	64%	—	$48 – $270
8	Anthem facility · fee schedule · outpatient · +13 other terms	59	$139	$161	$133	83%	—	$45 – $1.2k
9	WellCare fee schedule · outpatient · +12 other terms	55	$135	$118	$342	290%	—	$45 – $3.6k
10	Ambetter facility · fee schedule · outpatient · +9 other terms	53	$212	$230	$38	17%	—	$52 – $269
11	Kaiser fee schedule · outpatient · +10 other terms	50	$261	$1.9k	$3.2k	171%	—	$109 – $16.1k
12	Devoted facility · fee schedule · outpatient · +7 other terms	39	$118	$122	$8	7%	—	$112 – $143
13	Optum fee schedule · outpatient · +7 other terms	33	$125	$545	$1.1k	200%	—	$113 – $4.9k
14	Baylor Scott White Health Plan facility · fee schedule · outpatient · +2 other terms	25	$158	$158	$31	20%	—	$119 – $207
15	Medcost percent of total billed charges · bothfrom % of charges · +3 other terms	25	$327	$142	$130	91%	—	$82 – $935
16	MultiPlan fee schedule · inpatient · +10 other terms	21	$9.3k	$12.6k	$5.8k	46%	—	$2.1k – $26.5k
17	Regence professional · fee schedule · outpatient · +4 other terms	21	$44	$49	$23	46%	—	$44 – $153
18	Superior Healthplan facility · fee schedule · outpatient · +3 other terms	21	$131	$129	$3	2%	—	$125 – $131
19	Healthpartners fee schedule · outpatient · +2 other terms	19	$62	$64	$11	18%	—	$61 – $131
20	Medical Mutual facility · fee schedule · outpatient · +6 other terms	19	$123	$131	$50	38%	—	$61 – $468
21	Oscar facility · fee schedule · outpatient · +9 other terms	19	$182	$155	$67	43%	—	$56 – $234
22	Medicare fee schedule · outpatient · +4 other terms	18	$125	$125	—	—	—	$125 – $125
23	Tricare fee schedule · outpatient · +3 other terms	17	$121	$123	$8	7%	—	$113 – $148
24	Highmark fee schedule · outpatient · +6 other terms	16	$68	$125	$341	274%	—	$60 – $3.4k
25	Wellmark fee schedule · both · +2 other terms	14	$55	$54	$2	3%	—	$45 – $55

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