Artacent AC 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

Artacent ac 1 sq cm

Payers reporting HCPCS Q4190

Payer pricing summary

Low

$91

Average

$275

Median

$244

High

$966

Payer rate distribution

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#
1	UnitedHealthcare fee schedule · outpatient · +11 other terms	433	$210	$296	$224	76%	—	$48 – $1.7k
2	Cigna fee schedule · outpatient · +9 other terms	292	$352	$422	$331	79%	—	$8 – $4.0k
3	Aetna fee schedule · outpatient · +11 other terms	243	$149	$225	$237	106%	—	$69 – $2.8k
4	Blue Cross Blue Shield fee schedule · outpatient · +7 other terms	204	$253	$495	$855	173%	—	$1 – $14.4k
5	Humana fee schedule · outpatient · +8 other terms	184	$172	$214	$284	133%	—	$48 – $1.7k
6	Molina fee schedule · outpatient · +7 other terms	81	$200	$294	$364	124%	—	$51 – $3.4k
7	Caresource fee schedule · outpatient · +3 other terms	61	$177	$157	$109	70%	—	$48 – $401
8	Anthem facility · fee schedule · outpatient · +6 other terms	55	$164	$210	$146	70%	—	$0 – $1.2k
9	WellCare fee schedule · outpatient · +6 other terms	49	$140	$145	$27	19%	—	$115 – $252
10	Ambetter fee schedule · outpatient · +4 other terms	42	$234	$279	$137	49%	—	$122 – $849
11	Kaiser fee schedule · outpatient · +4 other terms	42	$207	$273	$183	67%	—	$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	Bcbs Tx fee schedule · outpatient	30	$282	$290	$91	31%	—	$214 – $1.1k
15	Healthpartners fee schedule · outpatient · +3 other terms	19	$281	$277	$25	9%	—	$131 – $288
16	Oscar facility · fee schedule · outpatient · +4 other terms	19	$182	$185	$26	14%	—	$160 – $234
17	Medical Mutual facility · fee schedule · outpatient · +3 other terms	18	$237	$276	$138	50%	—	$64 – $552
18	Medicare fee schedule · outpatient · +1 other terms	18	$125	$125	—	—	—	$125 – $125
19	Highmark fee schedule · outpatient · +4 other terms	16	$220	$283	$338	119%	—	$127 – $3.4k
20	Wellmark fee schedule · both · +2 other terms	14	$177	$181	$30	17%	—	$129 – $363
21	Aetna Better Health fee schedule · outpatient · +3 other terms	11	$330	$409	$105	26%	—	$330 – $547
22	Bcbs Nj fee schedule · outpatient	11	$212	$210	$49	23%	—	$117 – $236
23	Tricare fee schedule · outpatient · +1 other terms	11	$113	$118	$10	8%	—	$113 – $148
24	Medica fee schedule · outpatient · +4 other terms	10	$897	$904	$226	25%	—	$544 – $1.2k
25	Regence fee schedule · outpatient · +4 other terms	10	$146	$146	$4	3%	—	$140 – $156

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