Novachor 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

Novachor 1 sq cm

Payers reporting HCPCS Q4194

Payer pricing summary

Low

Average

$1.6k

Median

$620

High

$14.4k

Payer rate distribution

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#
1	UnitedHealthcare fee schedule · outpatient · +14 other terms	430	$296	$700	$791	113%	—	$48 – $4.5k
2	Cigna fee schedule · outpatient · +11 other terms	267	$1.3k	$1.8k	$1.6k	89%	—	$119 – $6.1k
3	Aetna fee schedule · outpatient · +16 other terms	243	$147	$543	$969	178%	—	$69 – $10.3k
4	Blue Cross Blue Shield fee schedule · outpatient · +13 other terms	207	$133	$432	$960	222%	—	$1 – $14.4k
5	Humana fee schedule · outpatient · +13 other terms	184	$698	$500	$592	118%	—	$48 – $3.2k
6	Molina fee schedule · outpatient · +10 other terms	78	$201	$560	$760	136%	—	$51 – $3.4k
7	Caresource fee schedule · outpatient · +4 other terms	61	$719	$437	$494	113%	—	$48 – $1.5k
8	Anthem facility · fee schedule · outpatient · +8 other terms	55	$180	$510	$542	106%	—	$48 – $2.4k
9	WellCare fee schedule · outpatient · +6 other terms	49	$140	$213	$211	99%	—	$115 – $913
10	Kaiser fee schedule · outpatient · +5 other terms	41	$207	$295	$270	92%	—	$125 – $1.8k
11	Ambetter fee schedule · outpatient · +5 other terms	39	$247	$383	$378	99%	—	$162 – $1.5k
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	$1.0k	$1.0k	$147	15%	—	$131 – $1.0k
16	Oscar facility · fee schedule · outpatient · +2 other terms	19	$234	$402	$318	79%	—	$175 – $890
17	Medical Mutual facility · fee schedule · outpatient · +3 other terms	18	$1.2k	$1.3k	$975	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	$890	$876	$295	34%	—	$127 – $3.4k
20	Phcs percent of total billed charges · bothfrom % of charges	15	$12.1k	$11.5k	$1.9k	17%	—	$7.6k – $14.2k
21	Wellmark fee schedule · both · +5 other terms	14	$719	$722	$19	3%	—	$718 – $840
22	Bcbs Nj fee schedule · outpatient	11	$825	$822	$70	9%	—	$689 – $859
23	Tricare fee schedule · outpatient · +1 other terms	11	$113	$118	$10	8%	—	$113 – $148
24	Beechstreet percent of total billed charges · bothfrom % of charges	10	$13.9k	$14.4k	$790	5%	—	$13.9k – $16.1k
25	Medica fee schedule · outpatient · +5 other terms	10	$2.1k	$2.1k	$526	25%	—	$1.3k – $2.7k

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