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

Amnio wound, per square cm

Payers reporting HCPCS Q4181

Payer pricing summary

Low

Average

$429

Median

$163

High

$3.6k

Payer rate distribution

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#
1	UnitedHealthcare fee schedule · outpatient · +11 other terms	412	$210	$248	$133	54%	—	$48 – $1.0k
2	Aetna fee schedule · outpatient · +11 other terms	151	$130	$152	$61	40%	—	$69 – $515
3	Blue Cross Blue Shield fee schedule · outpatient · +8 other terms	93	$133	$167	$92	55%	—	$1 – $580
4	Humana fee schedule · outpatient · +7 other terms	83	$125	$132	$28	21%	—	$48 – $360
5	Cigna fee schedule · outpatient · +5 other terms	73	$129	$167	$101	60%	—	$119 – $644
6	Anthem facility · fee schedule · outpatient · +7 other terms	51	$160	$188	$163	87%	—	$0 – $1.2k
7	Molina fee schedule · outpatient · +6 other terms	50	$192	$255	$397	156%	—	$51 – $3.4k
8	WellCare fee schedule · outpatient · +5 other terms	43	$136	$139	$14	10%	—	$119 – $171
9	Kaiser fee schedule · outpatient · +5 other terms	37	$207	$264	$188	71%	—	$125 – $1000
10	Ambetter fee schedule · outpatient · +3 other terms	33	$234	$246	$45	18%	—	$162 – $351
11	Devoted fee schedule · outpatient · +3 other terms	33	$125	$125	$7	6%	—	$116 – $136
12	Optum fee schedule · outpatient · +1 other terms	32	$125	$173	$91	53%	—	$113 – $459
13	Caresource fee schedule · outpatient · +2 other terms	21	$100	$96	$67	70%	—	$48 – $199
14	Medicare fee schedule · outpatient · +1 other terms	18	$125	$125	—	—	—	$125 – $125
15	Wellmark fee schedule · both · +1 other terms	13	$163	$160	$13	8%	—	$84 – $163
16	Medical Mutual facility · fee schedule · outpatient · +1 other terms	12	$118	$123	$13	11%	—	$118 – $167
17	Tricare fee schedule · outpatient · +1 other terms	11	$113	$118	$10	8%	—	$113 – $148
18	Bcbs Nj fee schedule · outpatient	10	$151	$151	—	—	—	$151 – $151
19	Medica fee schedule · outpatient · +4 other terms	10	$331	$334	$83	25%	—	$201 – $427
20	Oscar facility · fee schedule · outpatient · +2 other terms	10	$175	$177	$3	2%	—	$175 – $182
21	Regence fee schedule · outpatient · +6 other terms	10	$146	$146	$4	3%	—	$140 – $156
22	Bcbs La fee schedule · outpatient · +1 other terms	6	$164	$164	—	—	—	$164 – $164
23	Excellus fee schedule · outpatient · +2 other terms	6	$236	$230	$60	26%	—	$127 – $351
24	Highmark fee schedule · outpatient · +3 other terms	6	$176	$708	$979	138%	—	$127 – $3.4k
25	Aetna Better Health facility · fee schedule · outpatient	5	$68	$68	$1	1%	—	$68 – $70

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