Restorigin 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

Restorigin 1 sq cm

Payers reporting HCPCS Q4191

Payer pricing summary

Low

Average

$657

Median

$546

High

$2.5k

Payer rate distribution

Filter by billing methodology

Filter by billing class

#
1	UnitedHealthcare fee schedule · outpatient · +10 other terms	432	$296	$853	$1.1k	125%	—	$48 – $5.9k
2	Cigna fee schedule · outpatient · +9 other terms	292	$1.5k	$2.0k	$1.6k	82%	—	$119 – $9.0k
3	Aetna fee schedule · outpatient · +11 other terms	242	$149	$635	$1.2k	182%	—	$69 – $12.1k
4	Blue Cross Blue Shield fee schedule · outpatient · +6 other terms	204	$131	$483	$1.1k	235%	—	$1 – $14.4k
5	Humana fee schedule · outpatient · +8 other terms	184	$912	$707	$1.1k	151%	—	$48 – $5.8k
6	Molina fee schedule · outpatient · +6 other terms	81	$201	$613	$879	143%	—	$51 – $3.4k
7	Caresource fee schedule · outpatient · +4 other terms	61	$878	$508	$588	116%	—	$48 – $1.7k
8	Anthem facility · fee schedule · outpatient · +5 other terms	55	$177	$549	$611	111%	—	$0 – $2.5k
9	WellCare fee schedule · outpatient · +6 other terms	49	$140	$247	$309	125%	—	$115 – $1.3k
10	Ambetter fee schedule · outpatient · +4 other terms	42	$234	$574	$879	153%	—	$162 – $3.9k
11	Kaiser fee schedule · outpatient · +4 other terms	42	$207	$300	$299	100%	—	$125 – $2.1k
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	$8	$8	$3	31%	—	$6 – $30
15	Healthpartners fee schedule · outpatient · +1 other terms	19	$1.2k	$1.2k	$177	15%	—	$131 – $1.2k
16	Oscar facility · fee schedule · outpatient · +2 other terms	19	$234	$406	$325	80%	—	$175 – $906
17	Medical Mutual facility · fee schedule · outpatient · +3 other terms	18	$1.2k	$1.3k	$994	76%	—	$64 – $3.1k
18	Medicare fee schedule · outpatient · +1 other terms	18	$125	$125	—	—	—	$125 – $125
19	Highmark fee schedule · outpatient · +5 other terms	16	$1.2k	$1.1k	$327	29%	—	$127 – $3.4k
20	Wellmark fee schedule · both · +1 other terms	14	$940	$955	$132	14%	—	$730 – $1.7k
21	Aetna Better Health fee schedule · outpatient · +2 other terms	11	$1.6k	$1.7k	$154	9%	—	$1.6k – $1.9k
22	Bcbs Nj fee schedule · outpatient	11	$949	$944	$138	15%	—	$680 – $1.0k
23	Tricare fee schedule · outpatient · +1 other terms	11	$113	$118	$10	8%	—	$113 – $148
24	Medica fee schedule · outpatient · +4 other terms	10	$3.1k	$3.1k	$785	25%	—	$1.9k – $4.0k
25	Regence fee schedule · outpatient · +4 other terms	10	$146	$146	$4	3%	—	$140 – $156

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