Surgical skin graft 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

Surgigraft, 1 sq cm

Payers reporting HCPCS Q4183

Payer pricing summary

Low

Average

$182

Median

$148

High

$497

Payer rate distribution

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#
1	UnitedHealthcare fee schedule · outpatient · +15 other terms	436	$210	$245	$122	50%	—	$1 – $1.0k
2	Cigna fee schedule · outpatient · +14 other terms	230	$151	$219	$159	73%	—	$85 – $727
3	Aetna fee schedule · outpatient · +16 other terms	221	$127	$154	$90	58%	—	$69 – $867
4	Blue Cross Blue Shield fee schedule · outpatient · +11 other terms	177	$121	$263	$875	333%	—	$1 – $14.4k
5	Humana fee schedule · outpatient · +11 other terms	104	$125	$172	$52	30%	—	$48 – $360
6	Molina fee schedule · outpatient · +7 other terms	55	$193	$249	$385	155%	—	$51 – $3.4k
7	Anthem facility · fee schedule · outpatient · +6 other terms	51	$160	$188	$163	87%	—	$0 – $1.2k
8	WellCare fee schedule · outpatient · +7 other terms	46	$136	$139	$14	10%	—	$115 – $171
9	Kaiser fee schedule · outpatient · +4 other terms	39	$207	$265	$186	70%	—	$125 – $1000
10	Ambetter fee schedule · outpatient · +5 other terms	37	$234	$253	$51	20%	—	$162 – $406
11	Devoted fee schedule · outpatient · +4 other terms	33	$125	$125	$7	6%	—	$116 – $136
12	Optum fee schedule · outpatient · +3 other terms	32	$125	$173	$91	53%	—	$113 – $459
13	Bcbs Tx fee schedule · outpatient	30	$8	$8	$3	31%	—	$6 – $30
14	Caresource fee schedule · outpatient · +6 other terms	24	$100	$90	$63	70%	—	$48 – $213
15	Medicare fee schedule · outpatient	21	$125	$124	$1	1%	—	$121 – $125
16	Oscar facility · fee schedule · outpatient · +4 other terms	19	$182	$196	$25	13%	—	$175 – $234
17	Highmark fee schedule · outpatient · +4 other terms	16	$94	$147	$337	229%	—	$85 – $3.4k
18	Tricare fee schedule · outpatient · +1 other terms	16	$121	$122	$8	7%	—	$113 – $148
19	Medical Mutual facility · fee schedule · outpatient · +2 other terms	14	$118	$150	$96	64%	—	$64 – $468
20	Wellmark fee schedule · both · +2 other terms	13	$90	$89	$7	7%	—	$49 – $90
21	Bcbs Nj fee schedule · outpatient	12	$83	$83	—	—	—	$83 – $83
22	Medica fee schedule · outpatient · +4 other terms	10	$327	$329	$82	25%	—	$198 – $422
23	Regence fee schedule · outpatient · +4 other terms	10	$146	$146	$4	3%	—	$140 – $156
24	Clover facility · fee schedule · outpatient · +1 other terms	8	$123	$123	$6	5%	—	$117 – $134
25	Aetna Better Health fee schedule · inpatient · +2 other terms	7	$82	$82	—	—	—	$82 – $82

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