Amniotic membrane wound 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

Amniply, per sq cm

Payers reporting HCPCS Q4249

Payer pricing summary

Low

Average

$865

Median

$503

High

$3.6k

Payer rate distribution

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Filter by billing class

#
1	UnitedHealthcare fee schedule · outpatient · +9 other terms	423	$296	$1.7k	$2.5k	150%	—	$48 – $16.9k
2	Cigna fee schedule · outpatient · +7 other terms	239	$2.3k	$4.2k	$4.2k	100%	—	$119 – $15.3k
3	Aetna fee schedule · outpatient · +9 other terms	223	$146	$1.1k	$2.6k	227%	—	$69 – $23.4k
4	Blue Cross Blue Shield fee schedule · outpatient · +6 other terms	163	$121	$211	$522	247%	—	$1 – $3.1k
5	Humana fee schedule · outpatient · +7 other terms	102	$128	$328	$522	159%	—	$48 – $2.2k
6	Molina fee schedule · outpatient · +7 other terms	59	$196	$337	$522	155%	—	$51 – $3.4k
7	WellCare fee schedule · outpatient · +5 other terms	46	$136	$139	$14	10%	—	$115 – $171
8	Kaiser fee schedule · outpatient · +4 other terms	39	$207	$352	$647	184%	—	$125 – $4.8k
9	Anthem facility · fee schedule · outpatient · +5 other terms	36	$186	$1.1k	$1.5k	142%	—	$48 – $7.1k
10	Ambetter fee schedule · outpatient · +3 other terms	34	$234	$289	$248	86%	—	$162 – $1.7k
11	Caresource fee schedule · outpatient · +3 other terms	33	$136	$362	$770	213%	—	$48 – $3.0k
12	Devoted fee schedule · outpatient · +3 other terms	33	$125	$125	$7	6%	—	$116 – $136
13	Optum fee schedule · outpatient · +2 other terms	32	$125	$173	$91	53%	—	$113 – $459
14	Bcbs Tx fee schedule · outpatient	30	$8	$8	$3	31%	—	$6 – $30
15	Oscar facility · fee schedule · outpatient · +1 other terms	19	$234	$795	$924	116%	—	$175 – $2.2k
16	Medical Mutual facility · fee schedule · outpatient · +3 other terms	18	$2.9k	$3.1k	$2.5k	81%	—	$64 – $7.6k
17	Medicare fee schedule · outpatient · +1 other terms	18	$125	$125	—	—	—	$125 – $125
18	Highmark fee schedule · outpatient · +4 other terms	16	$2.5k	$2.4k	$591	25%	—	$127 – $3.4k
19	Wellmark fee schedule · both · +1 other terms	14	$2.3k	$2.2k	$248	11%	—	$738 – $2.3k
20	Bcbs Nj fee schedule · outpatient	11	$2.2k	$2.2k	$81	4%	—	$2.0k – $2.2k
21	Tricare fee schedule · outpatient · +1 other terms	11	$113	$118	$10	8%	—	$113 – $148
22	Medica fee schedule · outpatient · +4 other terms	10	$1.2k	$1.2k	$308	25%	—	$741 – $1.6k
23	Regence fee schedule · outpatient · +4 other terms	10	$146	$146	$4	3%	—	$140 – $156
24	Clover facility · fee schedule · outpatient · +2 other terms	8	$123	$123	$6	5%	—	$117 – $134
25	Aetna Better Health fee schedule · inpatient · +2 other terms	7	$724	$724	—	—	—	$724 – $724

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