Amniotic membrane patch, 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

Human health factor 10 amniotic patch (hhf10-p), per square centimeter (add-on, list separately in addition to primary procedure)

Payers reporting HCPCS Q4224

Payer pricing summary

Low

Average

$200

Median

$141

High

$785

Payer rate distribution

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#
1	UnitedHealthcare fee schedule · outpatient · +7 other terms	207	$210	$225	$74	33%	—	$48 – $484
2	Blue Cross Blue Shield fee schedule · outpatient · +5 other terms	61	$9	$11	$9	84%	—	$1 – $122
3	Bcbs Tx fee schedule · outpatient	30	$8	$8	$3	31%	—	$6 – $30
4	Humana fee schedule · outpatient · +6 other terms	26	$133	$125	$20	16%	—	$48 – $146
5	Molina facility · case rate · outpatient · +5 other terms	23	$943	$693	$506	73%	—	$61 – $1.7k
6	Anthem facility · fee schedule · outpatient · +5 other terms	21	$49	$107	$64	59%	—	$48 – $389
7	Cigna fee schedule · outpatient · +3 other terms	21	$133	$125	$4	3%	—	$123 – $133
8	Aetna fee schedule · outpatient · +6 other terms	19	$133	$149	$40	27%	—	$130 – $306
9	Caresource facility · case rate · outpatient · +3 other terms	19	$968	$858	$460	54%	—	$49 – $1.7k
10	Medicare fee schedule · outpatient	18	$133	$133	—	—	—	$133 – $133
11	WellCare facility · fee schedule · outpatient · +4 other terms	15	$116	$119	$6	5%	—	$116 – $139
12	Kaiser fee schedule · outpatient · +3 other terms	13	$133	$133	—	—	—	$133 – $133
13	Optum facility · case rate · outpatient · +1 other terms	11	$940	$1.0k	$231	22%	—	$848 – $1.5k
14	Medical Mutual facility · fee schedule · outpatient	10	$116	$143	$30	21%	—	$116 – $184
15	Devoted fee schedule · outpatient · +3 other terms	9	$133	$133	—	—	—	$133 – $133
16	Ambetter facility · fee schedule · outpatient · +2 other terms	8	$209	$209	—	—	—	$209 – $209
17	Bcbs Mn fee schedule · outpatient	5	$1	$1	$0	66%	—	$0 – $1
18	Excellus facility · fee schedule · outpatient · +1 other terms	3	$252	$256	$189	74%	—	$103 – $565
19	First Health professional · fee schedule · both	3	$122	$122	—	—	—	$122 – $122
20	Highmark professional · fee schedule · both · +3 other terms	3	$111	$112	$3	2%	—	$111 – $116
21	Bcbs Al facility · case rate · outpatient	2	$125	$125	—	—	—	$125 – $125
22	Bcbs Ks fee schedule · outpatient	2	$133	$133	—	—	—	$133 – $133
23	Bcbs Mi facility · case rate · outpatient · +1 other terms	2	$61	$61	—	—	—	$61 – $61
24	Cigna Healthspring facility · case rate · outpatient	2	$134	$134	$7	5%	—	$127 – $140
25	Clover fee schedule · outpatient	2	$139	$139	—	—	—	$139 – $139

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