Dermavest or Plurivest 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

DERMAVEST, PLURIVEST SQ CM

Payers reporting HCPCS Q4153

Payer pricing summary

Low

$59

Average

$177

Median

$173

High

$435

Payer rate distribution

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#
1	UnitedHealthcare fee schedule · outpatient · +12 other terms	430	$210	$237	$135	57%	—	$47 – $884
2	Cigna fee schedule · outpatient · +8 other terms	285	$228	$307	$224	73%	—	$0 – $929
3	Aetna fee schedule · outpatient · +13 other terms	246	$144	$196	$213	108%	—	$69 – $2.8k
4	Humana fee schedule · outpatient · +8 other terms	184	$124	$141	$59	42%	—	$48 – $441
5	Blue Cross Blue Shield fee schedule · outpatient · +8 other terms	138	$133	$191	$120	63%	—	$1 – $639
6	Molina fee schedule · outpatient · +7 other terms	84	$200	$289	$360	125%	—	$51 – $3.4k
7	Caresource fee schedule · outpatient · +3 other terms	61	$128	$146	$107	73%	—	$48 – $396
8	Anthem facility · fee schedule · outpatient · +6 other terms	55	$175	$214	$148	69%	—	$48 – $1.2k
9	WellCare fee schedule · outpatient · +7 other terms	49	$135	$138	$14	10%	—	$115 – $171
10	Ambetter fee schedule · outpatient · +4 other terms	42	$234	$236	$52	22%	—	$102 – $351
11	Kaiser fee schedule · outpatient · +4 other terms	42	$207	$272	$182	67%	—	$125 – $1000
12	Devoted fee schedule · outpatient · +3 other terms	35	$125	$125	$8	6%	—	$116 – $139
13	Optum fee schedule · outpatient · +3 other terms	32	$125	$173	$91	53%	—	$113 – $459
14	Regence professional · fee schedule · outpatient · +4 other terms	21	$161	$160	$2	1%	—	$153 – $161
15	Healthpartners fee schedule · outpatient · +1 other terms	19	$278	$274	$25	9%	—	$131 – $284
16	Oscar facility · fee schedule · outpatient · +2 other terms	19	$182	$178	$35	20%	—	$135 – $234
17	Medical Mutual facility · fee schedule · outpatient · +3 other terms	18	$204	$241	$113	47%	—	$64 – $468
18	Medicare fee schedule · outpatient · +1 other terms	18	$125	$125	—	—	—	$125 – $125
19	Highmark fee schedule · outpatient · +4 other terms	16	$159	$213	$329	155%	—	$127 – $3.4k
20	Wellmark fee schedule · outpatient · +3 other terms	15	$128	$126	$6	5%	—	$109 – $128
21	Aetna Better Health fee schedule · outpatient · +2 other terms	11	$129	$135	$7	5%	—	$129 – $144
22	Bcbs Nj fee schedule · outpatient	11	$215	$213	$37	17%	—	$143 – $233
23	Tricare fee schedule · outpatient · +1 other terms	11	$113	$118	$10	8%	—	$113 – $148
24	Medica fee schedule · outpatient · +5 other terms	10	$236	$238	$59	25%	—	$143 – $305
25	Clover fee schedule · outpatient · +2 other terms	9	$128	$126	$7	6%	—	$120 – $140

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