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

Tricare pricing summary

Low

$109

Average

$1.5k

Median

$127

High

$10.2k

Tricare rate distribution

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42 hospital rates

#		Plans
1	CLAIBORNE MEDICAL CENTER Tazewell, TN fee schedule · outpatient	1	$121	$121	—	—	—	$121 – $121
2	CUMBERLAND MEDICAL CENTER, INC. Crossville, TN fee schedule · outpatient	1	$121	$121	—	—	—	$121 – $121
3	Canton-Potsdam Hospital Potsdam, NY facility · fee schedule · outpatient	1	$109	$109	—	—	—	$109 – $109
4	CentraState Medical Center Freehold Township, NJ other · outpatient	2	$8.3k	$8.3k	—	—	—	$8.3k – $8.3k
5	Central Maine Medical Center Lewiston, ME fee schedule · outpatient	1	$127	$127	—	—	—	$127 – $127
6	Charleston Area Medical Center Charleston, WV percent of total billed charges · bothfrom % of charges	1	$9.9k	$10.2k	$1.8k	18%	—	$8.2k – $12.6k
7	Chilton Medical Center Pompton Plains, NJ other · outpatient	2	$8.3k	$8.3k	—	—	—	$8.3k – $8.3k
8	FORT LOUDOUN MEDICAL CENTER Lenoir City, TN fee schedule · outpatient	1	$113	$113	—	—	—	$113 – $113
9	FORT SANDERS REGIONAL MEDICAL CENTER Knoxville, TN fee schedule · outpatient	1	$113	$113	—	—	—	$113 – $113
10	HOULTON REGIONAL HOSPITAL HOULTON, ME percent of total billed charges · outpatientfrom % of charges	1	$256	$256	$6	3%	—	$250 – $262
11	Hackettstown Medical Center Hackettstown, NJ other · outpatient	2	$8.3k	$8.3k	—	—	—	$8.3k – $8.3k
12	Kaleida Health Buffalo, NY fee schedule · outpatient	1	$148	$148	—	—	—	$148 – $148
13	Kaweah Health Medical Center Visalia, CA facility · fee schedule · outpatient	1	$127	$127	—	—	—	$127 – $127
14	Kaweah Health Mental Health Hospital Visalia, CA facility · fee schedule · outpatient	1	$525	$525	—	—	—	$525 – $525
15	LECONTE MEDICAL CENTER Sevierville, TN fee schedule · outpatient	1	$121	$121	—	—	—	$121 – $121
16	METHODIST MEDICAL CENTER OF OAK RIDGE Oak Ridge, TN fee schedule · outpatient	1	$113	$113	—	—	—	$113 – $113
17	MORRISTOWN HAMBLEN HOSPITAL ASSOCIATION Morristown, TN fee schedule · outpatient	1	$113	$113	—	—	—	$113 – $113
18	McLeod Health Dillon, SC fee schedule · both	1	$136	$136	—	—	—	$136 – $136
19	McLeod Health Cheraw, SC fee schedule · both	1	$136	$136	—	—	—	$136 – $136
20	McLeod Health Manning, SC fee schedule · both	1	$136	$136	—	—	—	$136 – $136
21	McLeod Health Florence, SC fee schedule · both	1	$136	$136	—	—	—	$136 – $136
22	McLeod Health Beach, SC fee schedule · both	1	$136	$136	—	—	—	$136 – $136
23	McLeod Health Loris, SC fee schedule · both	1	$136	$136	—	—	—	$136 – $136
24	McLeod Health River, SC fee schedule · both	1	$136	$136	—	—	—	$136 – $136
25	Morristown Medical Center Morristown, NJ other · outpatient	2	$8.3k	$8.3k	—	—	—	$8.3k – $8.3k