Miroderm 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

GRAFT MIRODERM FEN 2CMX3CM

Payers reporting HCPCS Q4175

Payer pricing summary

Low

$49

Average

$398

Median

$168

High

$2.7k

Payer rate distribution

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Filter by billing class

#
1	UnitedHealthcare fee schedule · outpatient · +18 other terms	431	$160	$175	$96	55%	—	$44 – $613
2	Cigna fee schedule · outpatient · +15 other terms	298	$128	$218	$266	122%	—	$54 – $2.0k
3	Aetna fee schedule · outpatient · +16 other terms	259	$128	$269	$473	176%	—	$63 – $2.0k
4	Humana fee schedule · outpatient · +14 other terms	184	$104	$106	$43	40%	—	$48 – $360
5	Blue Cross Blue Shield fee schedule · outpatient · +15 other terms	153	$125	$162	$105	64%	—	$1 – $681
6	Molina fee schedule · outpatient · +10 other terms	84	$168	$225	$342	152%	—	$51 – $3.4k
7	Caresource fee schedule · outpatient · +6 other terms	61	$100	$95	$50	53%	—	$48 – $213
8	Anthem facility · fee schedule · outpatient · +11 other terms	55	$161	$164	$143	88%	—	$48 – $1.2k
9	WellCare fee schedule · outpatient · +12 other terms	51	$135	$130	$25	19%	—	$69 – $171
10	Ambetter fee schedule · outpatient · +8 other terms	42	$234	$226	$57	25%	—	$64 – $351
11	Kaiser fee schedule · outpatient · +5 other terms	42	$207	$267	$181	68%	—	$125 – $1000
12	Devoted fee schedule · outpatient · +4 other terms	36	$125	$125	$8	6%	—	$116 – $139
13	Optum fee schedule · outpatient · +4 other terms	33	$125	$179	$92	51%	—	$113 – $459
14	Highmark facility · fee schedule · outpatient · +6 other terms	21	$117	$143	$77	54%	—	$69 – $401
15	Regence professional · fee schedule · outpatient · +7 other terms	21	$63	$68	$19	28%	—	$63 – $153
16	Healthpartners fee schedule · outpatient · +2 other terms	19	$82	$84	$8	10%	—	$81 – $131
17	Oscar facility · fee schedule · outpatient · +7 other terms	19	$182	$163	$55	34%	—	$84 – $234
18	Medical Mutual facility · fee schedule · outpatient · +3 other terms	18	$141	$171	$73	43%	—	$64 – $468
19	Medicare fee schedule · outpatient · +6 other terms	18	$125	$125	—	—	—	$125 – $125
20	Wellmark fee schedule · both · +2 other terms	14	$69	$69	$1	1%	—	$68 – $74
21	Bcbs Mn fee schedule · outpatient · +3 other terms	12	$1.2k	$793	$680	86%	—	$1 – $1.5k
22	Tricare fee schedule · outpatient · +3 other terms	12	$113	$119	$10	8%	—	$113 – $148
23	Aetna Better Health fee schedule · outpatient · +4 other terms	11	$67	$72	$5	8%	—	$67 – $79
24	Bcbs Nj fee schedule · outpatient	11	$74	$75	$11	14%	—	$69 – $95
25	Medica fee schedule · outpatient · +8 other terms	10	$129	$130	$33	25%	—	$78 – $167

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