Progenamatrix tissue 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

Progenamatrix, per sq cm

Payers reporting HCPCS Q4222

Payer pricing summary

Low

Average

$277

Median

$165

High

$2.1k

Payer rate distribution

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#
1	UnitedHealthcare fee schedule · outpatient · +11 other terms	431	$210	$214	$109	51%	—	$48 – $850
2	Cigna fee schedule · outpatient · +12 other terms	293	$204	$363	$353	97%	—	$97 – $2.1k
3	Aetna fee schedule · outpatient · +14 other terms	248	$133	$308	$508	165%	—	$69 – $2.1k
4	Blue Cross Blue Shield fee schedule · outpatient · +9 other terms	201	$127	$112	$124	111%	—	$1 – $818
5	Humana fee schedule · outpatient · +10 other terms	184	$132	$139	$42	30%	—	$48 – $360
6	Molina fee schedule · outpatient · +8 other terms	84	$200	$245	$340	139%	—	$51 – $3.4k
7	Caresource fee schedule · outpatient · +3 other terms	61	$136	$125	$61	49%	—	$48 – $217
8	Anthem facility · fee schedule · outpatient · +7 other terms	54	$161	$191	$151	79%	—	$48 – $1.2k
9	WellCare fee schedule · outpatient · +9 other terms	50	$136	$138	$13	10%	—	$115 – $171
10	Ambetter fee schedule · outpatient · +6 other terms	42	$234	$246	$47	19%	—	$120 – $351
11	Kaiser fee schedule · outpatient · +6 other terms	42	$207	$268	$180	67%	—	$125 – $1000
12	Devoted fee schedule · outpatient · +4 other terms	36	$125	$125	$8	6%	—	$116 – $139
13	Optum fee schedule · outpatient · +3 other terms	32	$125	$173	$91	53%	—	$113 – $459
14	Bcbs Tx fee schedule · outpatient	30	$11	$12	$4	31%	—	$9 – $43
15	Healthpartners fee schedule · outpatient · +1 other terms	19	$140	$139	$3	2%	—	$131 – $143
16	Oscar facility · fee schedule · outpatient · +2 other terms	19	$182	$185	$27	15%	—	$158 – $234
17	Medical Mutual facility · fee schedule · outpatient · +3 other terms	18	$234	$273	$136	50%	—	$64 – $544
18	Medicare fee schedule · outpatient · +2 other terms	18	$125	$125	—	—	—	$125 – $125
19	Highmark fee schedule · outpatient · +5 other terms	16	$168	$216	$327	151%	—	$127 – $3.4k
20	Wellmark fee schedule · both · +1 other terms	14	$136	$136	$2	1%	—	$128 – $136
21	Aetna Better Health fee schedule · outpatient · +2 other terms	11	$119	$117	$3	2%	—	$113 – $119
22	Bcbs Nj fee schedule · outpatient	11	$124	$124	$14	11%	—	$117 – $151
23	Tricare fee schedule · outpatient · +2 other terms	11	$113	$118	$10	8%	—	$113 – $148
24	Medica fee schedule · outpatient · +4 other terms	10	$185	$186	$46	25%	—	$112 – $239
25	Regence fee schedule · outpatient · +4 other terms	10	$146	$146	$4	3%	—	$140 – $156

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