Skin substitute 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

Skin te, per square centimeter (add-on, list separately in addition to primary procedure)

Payers reporting HCPCS Q4200

Payer pricing summary

Low

Average

$4.7k

Median

$255

High

$19.8k

Payer rate distribution

Filter by billing methodology

Filter by billing class

#
1	UnitedHealthcare fee schedule · outpatient · +13 other terms	259	$210	$1.4k	$4.3k	298%	—	$48 – $30.7k
2	Blue Cross Blue Shield fee schedule · outpatient · +10 other terms	117	$14	$268	$958	358%	—	$0 – $14.4k
3	Aetna fee schedule · outpatient · +15 other terms	107	$127	$187	$346	185%	—	$69 – $2.8k
4	Humana fee schedule · outpatient · +9 other terms	75	$125	$128	$17	13%	—	$48 – $171
5	Cigna fee schedule · outpatient · +10 other terms	61	$134	$3.0k	$7.5k	253%	—	$119 – $39.2k
6	WellCare fee schedule · outpatient · +6 other terms	41	$135	$138	$14	10%	—	$119 – $171
7	Anthem facility · fee schedule · outpatient · +8 other terms	37	$118	$152	$128	84%	—	$0 – $1.2k
8	Molina facility · fee schedule · outpatient · +7 other terms	36	$118	$124	$35	28%	—	$65 – $319
9	Bcbs Tx fee schedule · outpatient	30	$8	$8	$3	31%	—	$6 – $30
10	Devoted facility · fee schedule · outpatient · +5 other terms	26	$118	$121	$7	6%	—	$114 – $143
11	Kaiser fee schedule · outpatient · +7 other terms	25	$125	$1.8k	$3.0k	169%	—	$125 – $14.6k
12	Optum fee schedule · outpatient · +2 other terms	22	$125	$151	$98	65%	—	$113 – $459
13	Ambetter fee schedule · outpatient · +4 other terms	20	$272	$267	$41	15%	—	$218 – $351
14	Medicare fee schedule · outpatient	18	$125	$125	—	—	—	$125 – $125
15	Caresource facility · fee schedule · outpatient · +5 other terms	16	$212	$208	$25	12%	—	$121 – $238
16	Medical Mutual facility · fee schedule · outpatient · +4 other terms	13	$118	$119	$3	3%	—	$118 – $127
17	Oscar facility · fee schedule · outpatient · +2 other terms	11	$175	$177	$3	2%	—	$175 – $182
18	Tricare fee schedule · outpatient · +2 other terms	11	$113	$116	$5	4%	—	$113 – $127
19	Regence fee schedule · outpatient · +4 other terms	10	$146	$146	$4	3%	—	$140 – $156
20	Amerihealth Caritas percent of total billed charges · outpatientfrom % of charges	7	$16.6k	$17.8k	$15.1k	85%	—	$2.0k – $58.5k
21	Magellan percent of total billed charges · outpatientfrom % of charges	7	$16.6k	$17.8k	$15.1k	85%	—	$2.0k – $58.5k
22	Phcs percent of total billed charges · outpatientfrom % of charges · +3 other terms	7	$16.6k	$17.8k	$15.1k	85%	—	$2.0k – $58.5k
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 · +1 other terms	5	$68	$68	$1	1%	—	$68 – $70

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