Biovance amniotic tissue 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

Q4154

Payers reporting HCPCS Q4154

Payer pricing summary

Low

$64

Average

$976

Median

$354

High

$10.1k

Payer rate distribution

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Filter by billing class

#
1	UnitedHealthcare fee schedule · outpatient · +18 other terms	462	$210	$412	$799	194%	—	$33 – $7.3k
2	Cigna fee schedule · outpatient · +17 other terms	296	$217	$386	$565	147%	—	$0 – $7.3k
3	Aetna fee schedule · outpatient · +19 other terms	264	$146	$196	$164	84%	—	$46 – $1.7k
4	Humana fee schedule · outpatient · +15 other terms	197	$130	$305	$673	220%	—	$45 – $5.3k
5	Blue Cross Blue Shield fee schedule · outpatient · +18 other terms	176	$160	$482	$1.1k	227%	—	$1 – $7.4k
6	Molina fee schedule · outpatient · +12 other terms	90	$196	$216	$312	144%	—	$37 – $3.4k
7	Caresource fee schedule · outpatient · +8 other terms	62	$134	$134	$70	52%	—	$48 – $245
8	Anthem facility · fee schedule · outpatient · +12 other terms	59	$164	$204	$137	67%	—	$48 – $1.2k
9	WellCare fee schedule · outpatient · +12 other terms	57	$134	$112	$35	31%	—	$40 – $171
10	Kaiser fee schedule · outpatient · +8 other terms	44	$226	$428	$888	207%	—	$125 – $5.2k
11	Ambetter fee schedule · outpatient · +5 other terms	42	$234	$251	$55	22%	—	$135 – $402
12	Devoted fee schedule · outpatient · +7 other terms	34	$125	$126	$8	6%	—	$116 – $139
13	Optum fee schedule · outpatient · +4 other terms	33	$125	$170	$91	53%	—	$94 – $459
14	MultiPlan fee schedule · inpatient · +10 other terms	28	$3.3k	$2.3k	$2.3k	104%	—	$176 – $8.1k
15	Medica fee schedule · outpatient · +8 other terms	27	$626	$1.4k	$1.9k	137%	—	$136 – $7.1k
16	Regence professional · fee schedule · outpatient · +6 other terms	26	$158	$161	$4	2%	—	$151 – $165
17	Oscar facility · fee schedule · outpatient · +7 other terms	21	$182	$176	$29	16%	—	$143 – $234
18	Healthpartners fee schedule · outpatient · +4 other terms	19	$172	$171	$8	4%	—	$131 – $176
19	Medical Mutual facility · fee schedule · outpatient · +3 other terms	18	$259	$299	$155	52%	—	$64 – $610
20	Medicare fee schedule · outpatient · +5 other terms	18	$125	$125	—	—	—	$125 – $125
21	Tricare fee schedule · outpatient · +5 other terms	17	$121	$121	$9	7%	—	$113 – $148
22	Highmark fee schedule · outpatient · +9 other terms	16	$165	$220	$329	149%	—	$127 – $3.4k
23	Wellmark fee schedule · outpatient · +4 other terms	16	$134	$144	$11	8%	—	$134 – $155
24	Bcbs Mn fee schedule · outpatient · +3 other terms	12	$108	$84	$57	68%	—	$1 – $135
25	Clover facility · fee schedule · outpatient · +3 other terms	12	$127	$127	$7	5%	—	$117 – $134

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