Surgigraft-dual skin graft material, 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

Surgigraft dual per sq cm

Payers reporting HCPCS Q4219

Payer pricing summary

Low

Average

$382

Median

$180

High

$2.1k

Payer rate distribution

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#
1	UnitedHealthcare fee schedule · outpatient · +10 other terms	423	$296	$716	$789	110%	—	$48 – $4.9k
2	Cigna fee schedule · outpatient · +8 other terms	222	$1.5k	$2.5k	$2.4k	94%	—	$101 – $8.7k
3	Aetna fee schedule · outpatient · +9 other terms	218	$145	$607	$1.2k	199%	—	$69 – $10.4k
4	Blue Cross Blue Shield fee schedule · outpatient · +8 other terms	168	$121	$123	$204	166%	—	$1 – $900
5	Humana fee schedule · outpatient · +6 other terms	89	$125	$190	$206	109%	—	$48 – $960
6	Molina fee schedule · outpatient · +6 other terms	55	$200	$304	$416	137%	—	$51 – $3.4k
7	Anthem facility · fee schedule · outpatient · +4 other terms	50	$161	$191	$162	85%	—	$48 – $1.2k
8	WellCare fee schedule · outpatient · +4 other terms	46	$136	$139	$14	10%	—	$115 – $171
9	Kaiser fee schedule · outpatient · +4 other terms	39	$207	$302	$315	105%	—	$125 – $2.1k
10	Ambetter fee schedule · outpatient · +2 other terms	34	$234	$245	$45	18%	—	$162 – $351
11	Devoted fee schedule · outpatient · +3 other terms	33	$125	$125	$7	6%	—	$116 – $136
12	Optum fee schedule · outpatient · +1 other terms	32	$125	$173	$91	53%	—	$113 – $459
13	Bcbs Tx fee schedule · outpatient	30	$8	$8	$3	31%	—	$6 – $30
14	Caresource fee schedule · outpatient · +5 other terms	24	$100	$94	$65	69%	—	$48 – $213
15	Oscar facility · fee schedule · outpatient · +3 other terms	19	$182	$196	$25	13%	—	$175 – $234
16	Medicare fee schedule · outpatient	18	$125	$125	—	—	—	$125 – $125
17	Highmark fee schedule · outpatient · +4 other terms	16	$1.1k	$1.1k	$313	29%	—	$127 – $3.4k
18	Tricare fee schedule · outpatient · +1 other terms	16	$121	$121	$9	8%	—	$113 – $148
19	Medical Mutual facility · fee schedule · outpatient · +2 other terms	14	$118	$150	$96	64%	—	$64 – $468
20	Wellmark fee schedule · both · +2 other terms	13	$900	$878	$134	15%	—	$60 – $900
21	Bcbs Nj fee schedule · outpatient	12	$863	$868	$70	8%	—	$830 – $996
22	Medica fee schedule · outpatient · +4 other terms	10	$1.6k	$1.6k	$403	25%	—	$970 – $2.1k
23	Regence fee schedule · outpatient · +4 other terms	10	$146	$146	$4	3%	—	$140 – $156
24	Clover facility · fee schedule · outpatient · +1 other terms	8	$123	$123	$6	5%	—	$117 – $134
25	Aetna Better Health fee schedule · inpatient · +2 other terms	7	$989	$989	—	—	—	$989 – $989

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