Amniotic membrane 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

HC Matrix Amnion 3x4cm Thick <12 Sq Cm>

Payers reporting HCPCS Q4211

Payer pricing summary

Low

Average

$316

Median

$330

High

$802

Payer rate distribution

Filter by billing methodology

Filter by billing class

#
1	UnitedHealthcare fee schedule · outpatient · +16 other terms	251	$210	$217	$89	41%	—	$48 – $524
2	Blue Cross Blue Shield fee schedule · outpatient · +13 other terms	93	$16	$37	$49	131%	—	$0 – $354
3	Aetna fee schedule · outpatient · +14 other terms	89	$125	$192	$314	164%	—	$69 – $2.0k
4	Humana fee schedule · outpatient · +7 other terms	67	$125	$127	$14	11%	—	$48 – $171
5	Cigna fee schedule · outpatient · +8 other terms	58	$131	$193	$192	100%	—	$119 – $1.4k
6	WellCare fee schedule · outpatient · +6 other terms	39	$135	$137	$13	9%	—	$119 – $171
7	Anthem facility · fee schedule · outpatient · +7 other terms	35	$118	$212	$188	88%	—	$48 – $1.2k
8	Molina facility · fee schedule · outpatient · +9 other terms	35	$118	$130	$50	39%	—	$65 – $319
9	Bcbs Tx fee schedule · outpatient	30	$11	$12	$4	31%	—	$9 – $43
10	Phcs facility · percent of total billed charges · bothfrom % of charges · +2 other terms	27	$540	$548	$251	46%	—	$169 – $1.0k
11	Devoted facility · fee schedule · outpatient · +4 other terms	23	$118	$124	$11	9%	—	$118 – $143
12	Kaiser fee schedule · outpatient · +5 other terms	22	$125	$307	$247	80%	—	$125 – $1000
13	Optum fee schedule · outpatient · +3 other terms	22	$125	$151	$98	65%	—	$113 – $459
14	Ambetter fee schedule · outpatient · +3 other terms	20	$272	$255	$41	16%	—	$218 – $351
15	Medicare fee schedule · outpatient	18	$125	$125	—	—	—	$125 – $125
16	Caresource fee schedule · outpatient · +3 other terms	14	$258	$256	$215	84%	—	$48 – $524
17	Medcost facility · percent of total billed charges · bothfrom % of charges · +2 other terms	14	$437	$455	$186	41%	—	$204 – $873
18	Medical Mutual facility · fee schedule · outpatient · +4 other terms	12	$118	$123	$13	11%	—	$118 – $167
19	Amerihealth Caritas facility · percent of total billed charges · bothfrom % of charges · +1 other terms	11	$818	$686	$397	58%	—	$105 – $1.3k
20	Oscar facility · fee schedule · outpatient · +2 other terms	10	$175	$177	$3	2%	—	$175 – $182
21	Regence fee schedule · outpatient · +8 other terms	10	$146	$146	$4	3%	—	$140 – $156
22	Tricare fee schedule · outpatient · +2 other terms	10	$113	$115	$4	3%	—	$113 – $121
23	Magellan facility · percent of total billed charges · bothfrom % of charges	9	$408	$502	$413	82%	—	$105 – $1.8k
24	Excellus fee schedule · outpatient · +4 other terms	6	$236	$230	$60	26%	—	$127 – $351
25	Highmark fee schedule · outpatient · +5 other terms	6	$176	$708	$979	138%	—	$127 – $3.4k

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