Amniotic membrane graft 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

Amniotext patch, per sq cm

Payers reporting HCPCS Q4247

Payer pricing summary

Low

Average

$558

Median

$282

High

$5.0k

Payer rate distribution

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Filter by billing class

#
1	UnitedHealthcare fee schedule · outpatient · +10 other terms	417	$299	$1.8k	$2.5k	138%	—	$48 – $14.2k
2	Cigna fee schedule · outpatient · +9 other terms	237	$1.8k	$6.2k	$7.7k	124%	—	$119 – $26.8k
3	Aetna fee schedule · outpatient · +10 other terms	219	$147	$810	$1.7k	211%	—	$69 – $12.4k
4	Blue Cross Blue Shield fee schedule · outpatient · +6 other terms	154	$121	$129	$249	194%	—	$1 – $2.0k
5	Humana fee schedule · outpatient · +8 other terms	100	$127	$340	$601	177%	—	$48 – $3.0k
6	Molina fee schedule · outpatient · +7 other terms	54	$198	$365	$632	173%	—	$51 – $3.4k
7	WellCare fee schedule · outpatient · +5 other terms	47	$136	$138	$14	10%	—	$115 – $171
8	Kaiser fee schedule · outpatient · +3 other terms	39	$207	$309	$361	117%	—	$125 – $2.5k
9	Anthem facility · fee schedule · outpatient · +5 other terms	36	$118	$285	$371	130%	—	$48 – $1.7k
10	Ambetter fee schedule · outpatient · +3 other terms	33	$234	$246	$45	18%	—	$162 – $351
11	Devoted fee schedule · outpatient · +3 other terms	33	$125	$125	$7	6%	—	$116 – $136
12	Optum fee schedule · outpatient · +3 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 · +2 other terms	24	$100	$94	$65	69%	—	$48 – $213
15	Regence professional · fee schedule · outpatient · +4 other terms	20	$530	$512	$80	16%	—	$153 – $530
16	Healthpartners fee schedule · outpatient · +1 other terms	19	$633	$619	$82	13%	—	$131 – $647
17	Oscar facility · fee schedule · outpatient · +1 other terms	19	$182	$196	$25	13%	—	$175 – $234
18	Medical Mutual facility · fee schedule · outpatient · +3 other terms	18	$879	$964	$719	75%	—	$64 – $2.3k
19	Medicare fee schedule · outpatient	18	$125	$125	—	—	—	$125 – $125
20	Highmark fee schedule · outpatient · +4 other terms	16	$1.3k	$1.3k	$494	37%	—	$127 – $3.5k
21	Wellmark fee schedule · both · +1 other terms	13	$500	$500	—	—	—	$500 – $500
22	Bcbs Nj fee schedule · outpatient	12	$619	$640	$298	46%	—	$477 – $1.2k
23	Aetna Better Health fee schedule · outpatient · +3 other terms	11	$546	$586	$53	9%	—	$546 – $656
24	Bcbs La fee schedule · outpatient · +2 other terms	11	$518	$518	—	—	—	$518 – $518
25	Tricare fee schedule · outpatient · +2 other terms	11	$113	$118	$10	8%	—	$113 – $148

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