Amniotic tissue fluid graft, per 1 mg

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

AMNIOX CLARIX FLO REGEN 100MG

Payers reporting HCPCS Q4155

Payer pricing summary

Low

Average

$1.4k

Median

$1.4k

High

$5.0k

Payer rate distribution

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#
1	UnitedHealthcare fee schedule · outpatient · +13 other terms	401	$56	$166	$563	339%	—	$1 – $7.0k
2	Cigna fee schedule · outpatient · +16 other terms	270	$51	$358	$935	261%	—	$4 – $5.5k
3	Humana fee schedule · outpatient · +13 other terms	100	$26	$77	$233	302%	—	$1 – $1.6k
4	Aetna fee schedule · outpatient · +18 other terms	85	$35	$1.1k	$1.8k	156%	—	$1 – $7.5k
5	Blue Cross Blue Shield facility · fee schedule · outpatient · +15 other terms	58	$61	$62	$95	152%	—	$1 – $750
6	Caresource fee schedule · outpatient · +11 other terms	50	$48	$188	$219	117%	—	$1 – $524
7	Molina fee schedule · outpatient · +11 other terms	33	$70	$695	$780	112%	—	$1 – $3.4k
8	Amerihealth Caritas other · outpatient · +4 other terms	25	$760	$2.7k	$4.9k	184%	—	$12 – $15.1k
9	MultiPlan fee schedule · inpatient · +11 other terms	23	$3.9k	$4.1k	$2.1k	51%	—	$19 – $10.3k
10	Aetna Better Health other · outpatient · +5 other terms	19	$587	$770	$742	96%	—	$12 – $4.7k
11	Anthem fee schedule · outpatient · +14 other terms	19	$1.4k	$1.9k	$1.3k	68%	—	$37 – $4.8k
12	Beechstreet percent of total billed charges · outpatientfrom % of charges · +1 other terms	19	$713	$819	$608	74%	—	$64 – $3.8k
13	Healthpartners fee schedule · outpatient · +1 other terms	18	$34	$34	$1	2%	—	$34 – $35
14	Medcost percent of total billed charges · inpatientfrom % of charges · +4 other terms	17	$439	$421	$238	57%	—	$82 – $1.2k
15	Kaiser fee schedule · outpatient · +8 other terms	14	$1.8k	$2.3k	$1.7k	73%	—	$60 – $7.5k
16	Wellmark fee schedule · both · +3 other terms	14	$26	$26	$0	1%	—	$26 – $27
17	WellCare other · outpatient · +6 other terms	13	$2.0k	$7.6k	$6.8k	90%	—	$292 – $14.9k
18	First Health fee schedule · inpatient · +11 other terms	12	$3.1k	$3.3k	$1.5k	45%	—	$1.1k – $6.6k
19	Highmark fee schedule · outpatient · +9 other terms	12	$33	$86	$357	417%	—	$31 – $3.4k
20	Oscar facility · fee schedule · outpatient · +8 other terms	12	$34	$34	$0	1%	—	$33 – $34
21	Ambetter other · outpatient · +8 other terms	11	$14.9k	$4.5k	$5.7k	128%	—	$744 – $14.9k
22	Bcbs Nj fee schedule · outpatient · +1 other terms	11	$29	$28	$0	2%	—	$28 – $29
23	Medical Mutual facility · fee schedule · outpatient · +5 other terms	11	$74	$78	$21	27%	—	$37 – $117
24	Medica fee schedule · outpatient · +7 other terms	10	$67	$67	$17	25%	—	$41 – $86
25	Optum other · outpatient · +5 other terms	8	$1.3k	$1.2k	$616	50%	—	$292 – $2.7k

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