Amniotic membrane wound 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-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

Floweramniopatch, per sq cm

Payers reporting HCPCS Q4178

Payer pricing summary

Low

$29

Average

$363

Median

$140

High

$4.1k

Payer rate distribution

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#
1	UnitedHealthcare fee schedule · outpatient · +12 other terms	433	$207	$194	$95	49%	—	$48 – $613
2	Cigna fee schedule · outpatient · +11 other terms	287	$149	$247	$192	78%	—	$75 – $1.2k
3	Aetna fee schedule · outpatient · +12 other terms	251	$131	$162	$95	59%	—	$69 – $1.0k
4	Humana fee schedule · outpatient · +8 other terms	184	$103	$120	$48	40%	—	$48 – $360
5	Blue Cross Blue Shield fee schedule · outpatient · +10 other terms	151	$133	$186	$123	66%	—	$1 – $852
6	Molina fee schedule · outpatient · +7 other terms	81	$200	$236	$344	146%	—	$51 – $3.4k
7	Caresource fee schedule · outpatient · +7 other terms	61	$112	$108	$52	48%	—	$48 – $213
8	Anthem facility · fee schedule · outpatient · +7 other terms	55	$160	$168	$142	84%	—	$0 – $1.2k
9	WellCare fee schedule · outpatient · +7 other terms	49	$135	$133	$19	14%	—	$92 – $171
10	Ambetter fee schedule · outpatient · +4 other terms	42	$234	$234	$48	21%	—	$88 – $351
11	Kaiser fee schedule · outpatient · +5 other terms	42	$207	$267	$181	68%	—	$125 – $1000
12	Devoted fee schedule · outpatient · +3 other terms	35	$125	$125	$8	6%	—	$116 – $139
13	Optum fee schedule · outpatient · +2 other terms	32	$125	$173	$91	53%	—	$113 – $459
14	Healthpartners fee schedule · outpatient · +1 other terms	19	$104	$105	$5	5%	—	$102 – $131
15	Oscar facility · fee schedule · outpatient · +4 other terms	19	$182	$172	$42	24%	—	$115 – $234
16	Medical Mutual facility · fee schedule · outpatient · +4 other terms	18	$179	$215	$95	44%	—	$64 – $468
17	Medicare fee schedule · outpatient · +1 other terms	18	$125	$125	—	—	—	$125 – $125
18	Highmark fee schedule · outpatient · +4 other terms	16	$114	$168	$334	198%	—	$100 – $3.4k
19	Tricare fee schedule · outpatient · +1 other terms	16	$121	$121	$9	8%	—	$113 – $148
20	Wellmark fee schedule · both · +2 other terms	14	$92	$92	$1	1%	—	$84 – $93
21	Aetna Better Health fee schedule · outpatient · +2 other terms	11	$77	$88	$15	17%	—	$77 – $107
22	Bcbs Nj fee schedule · outpatient	11	$88	$88	$2	3%	—	$87 – $93
23	Medica fee schedule · outpatient · +6 other terms	10	$176	$177	$44	25%	—	$106 – $227
24	Regence fee schedule · outpatient · +4 other terms	10	$146	$146	$4	3%	—	$140 – $156
25	Clover fee schedule · outpatient · +2 other terms	9	$120	$114	$17	15%	—	$92 – $140

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