Amniotic membrane allograft, 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

Amniorepair or altiply sq cm

Payers reporting HCPCS Q4235

Payer pricing summary

Low

$79

Average

$948

Median

$172

High

$14.1k

Payer rate distribution

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#
1	UnitedHealthcare fee schedule · outpatient · +14 other terms	436	$210	$263	$659	251%	—	$48 – $11.3k
2	Cigna fee schedule · outpatient · +14 other terms	292	$174	$512	$1.6k	315%	—	$65 – $16.1k
3	Aetna fee schedule · outpatient · +16 other terms	246	$132	$161	$97	60%	—	$69 – $1.1k
4	Blue Cross Blue Shield fee schedule · outpatient · +10 other terms	195	$181	$242	$126	52%	—	$0 – $1.3k
5	Humana fee schedule · outpatient · +12 other terms	184	$116	$133	$85	64%	—	$48 – $558
6	Molina fee schedule · outpatient · +7 other terms	88	$196	$221	$323	146%	—	$51 – $3.4k
7	Caresource fee schedule · outpatient · +5 other terms	61	$100	$108	$53	49%	—	$48 – $213
8	Anthem facility · fee schedule · outpatient · +9 other terms	56	$161	$178	$146	82%	—	$48 – $1.2k
9	WellCare fee schedule · outpatient · +8 other terms	49	$135	$134	$17	13%	—	$95 – $171
10	Kaiser fee schedule · outpatient · +6 other terms	48	$207	$1.0k	$2.3k	224%	—	$95 – $11.5k
11	Ambetter fee schedule · outpatient · +6 other terms	42	$234	$242	$60	25%	—	$76 – $405
12	Devoted fee schedule · outpatient · +4 other terms	35	$125	$125	$8	6%	—	$116 – $139
13	Optum fee schedule · outpatient · +4 other terms	32	$125	$173	$91	53%	—	$113 – $459
14	Bcbs Tx fee schedule · outpatient	30	$237	$245	$76	31%	—	$181 – $893
15	Regence professional · fee schedule · outpatient · +4 other terms	21	$151	$150	$3	2%	—	$136 – $153
16	Oscar facility · fee schedule · outpatient · +3 other terms	20	$182	$169	$45	26%	—	$100 – $234
17	Healthpartners fee schedule · outpatient · +1 other terms	19	$114	$114	$4	3%	—	$111 – $131
18	Medical Mutual facility · fee schedule · outpatient · +3 other terms	18	$159	$193	$83	43%	—	$64 – $468
19	Medicare fee schedule · outpatient · +3 other terms	18	$125	$125	—	—	—	$125 – $125
20	Highmark fee schedule · outpatient · +5 other terms	16	$118	$168	$334	199%	—	$88 – $3.4k
21	Wellmark fee schedule · both · +1 other terms	14	$95	$96	$12	13%	—	$80 – $170
22	Aetna Better Health fee schedule · outpatient · +6 other terms	11	$154	$164	$13	8%	—	$154 – $182
23	Bcbs Nj fee schedule · outpatient	11	$94	$94	$2	2%	—	$91 – $95
24	Tricare fee schedule · outpatient · +3 other terms	11	$113	$118	$10	8%	—	$113 – $148
25	Medica fee schedule · outpatient · +4 other terms	10	$298	$301	$75	25%	—	$181 – $385

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