Dual-layer skin substitute 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

Celera per sq cm

Payers reporting HCPCS Q4259

Payer pricing summary

Low

Average

$695

Median

$559

High

$2.0k

Payer rate distribution

Filter by billing methodology

Filter by billing class

#
1	UnitedHealthcare fee schedule · outpatient · +10 other terms	430	$296	$918	$1.1k	122%	—	$48 – $6.1k
2	Cigna fee schedule · outpatient · +7 other terms	294	$1.5k	$2.2k	$2.0k	90%	—	$119 – $8.3k
3	Aetna fee schedule · outpatient · +9 other terms	241	$147	$712	$1.4k	199%	—	$69 – $15.3k
4	Blue Cross Blue Shield fee schedule · outpatient · +6 other terms	199	$128	$409	$839	205%	—	$1 – $5.0k
5	Humana fee schedule · outpatient · +8 other terms	184	$946	$625	$722	116%	—	$48 – $3.8k
6	Molina fee schedule · outpatient · +8 other terms	84	$201	$723	$1.1k	150%	—	$51 – $3.4k
7	Caresource fee schedule · outpatient · +4 other terms	61	$975	$591	$731	124%	—	$48 – $2.2k
8	Anthem facility · fee schedule · outpatient · +6 other terms	53	$177	$640	$710	111%	—	$48 – $2.6k
9	WellCare fee schedule · outpatient · +6 other terms	49	$140	$251	$319	127%	—	$115 – $1.4k
10	Ambetter fee schedule · outpatient · +4 other terms	42	$234	$570	$835	146%	—	$162 – $3.6k
11	Kaiser fee schedule · outpatient · +4 other terms	42	$207	$309	$359	116%	—	$125 – $2.7k
12	Devoted fee schedule · outpatient · +3 other terms	35	$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	$8	$8	$3	31%	—	$6 – $30
15	Healthpartners fee schedule · outpatient · +1 other terms	19	$1.5k	$1.5k	$229	15%	—	$131 – $1.6k
16	Oscar facility · fee schedule · outpatient · +2 other terms	19	$234	$484	$444	92%	—	$175 – $1.2k
17	Medicare fee schedule · outpatient · +1 other terms	18	$125	$125	—	—	—	$125 – $125
18	Medical Mutual facility · fee schedule · outpatient · +2 other terms	17	$142	$1.5k	$1.3k	88%	—	$64 – $4.0k
19	Highmark fee schedule · outpatient · +4 other terms	16	$1.2k	$1.2k	$327	28%	—	$127 – $3.4k
20	Wellmark fee schedule · both · +1 other terms	14	$975	$974	$5	1%	—	$941 – $975
21	Bcbs Nj fee schedule · outpatient	11	$1.2k	$1.2k	$222	19%	—	$740 – $1.3k
22	Tricare fee schedule · outpatient · +1 other terms	11	$113	$118	$10	8%	—	$113 – $148
23	Medica fee schedule · outpatient · +4 other terms	10	$2.0k	$2.0k	$509	25%	—	$1.2k – $2.6k
24	Regence fee schedule · outpatient · +4 other terms	10	$146	$146	$4	3%	—	$140 – $156
25	Clover fee schedule · outpatient · +2 other terms	9	$140	$409	$401	98%	—	$120 – $975

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