Surgical graft material, 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

Surgraft tl, per sq cm

Payers reporting HCPCS Q4263

Payer pricing summary

Low

Average

$786

Median

$679

High

$2.8k

Payer rate distribution

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#
1	UnitedHealthcare fee schedule · outpatient · +9 other terms	428	$296	$984	$1.4k	144%	—	$48 – $10.7k
2	Cigna fee schedule · outpatient · +7 other terms	301	$1.7k	$3.3k	$3.8k	116%	—	$68 – $14.6k
3	Aetna fee schedule · outpatient · +9 other terms	228	$148	$810	$1.6k	192%	—	$69 – $8.3k
4	Blue Cross Blue Shield fee schedule · outpatient · +6 other terms	193	$127	$476	$905	190%	—	$1 – $4.5k
5	Humana fee schedule · outpatient · +7 other terms	183	$1.0k	$930	$939	101%	—	$48 – $4.0k
6	Molina fee schedule · outpatient · +7 other terms	61	$196	$345	$510	148%	—	$51 – $3.4k
7	Anthem facility · fee schedule · outpatient · +5 other terms	53	$177	$1.0k	$1.5k	144%	—	$48 – $6.5k
8	Caresource fee schedule · outpatient · +3 other terms	49	$191	$619	$854	138%	—	$48 – $2.9k
9	WellCare fee schedule · outpatient · +5 other terms	49	$140	$278	$427	154%	—	$115 – $1.7k
10	Ambetter fee schedule · outpatient · +4 other terms	42	$234	$625	$966	155%	—	$162 – $3.5k
11	Kaiser fee schedule · outpatient · +4 other terms	42	$207	$291	$249	85%	—	$125 – $1.6k
12	Devoted fee schedule · outpatient · +3 other terms	34	$125	$125	$8	6%	—	$116 – $139
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	Healthpartners fee schedule · outpatient · +1 other terms	19	$635	$621	$83	13%	—	$131 – $649
16	Oscar facility · fee schedule · outpatient · +2 other terms	19	$234	$767	$881	115%	—	$175 – $2.1k
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	$2.7k	$2.5k	92%	—	$64 – $7.3k
19	Highmark fee schedule · outpatient · +4 other terms	16	$2.1k	$2.0k	$525	27%	—	$127 – $3.4k
20	Wellmark fee schedule · both · +1 other terms	14	$700	$737	$173	23%	—	$700 – $1.7k
21	Aetna Better Health fee schedule · outpatient · +2 other terms	11	$1.0k	$1.1k	$130	11%	—	$1.0k – $1.3k
22	Bcbs Nj fee schedule · outpatient	11	$974	$992	$468	47%	—	$747 – $1.9k
23	Tricare fee schedule · outpatient · +1 other terms	11	$113	$118	$10	8%	—	$113 – $148
24	Medica fee schedule · outpatient · +4 other terms	10	$2.1k	$2.2k	$538	25%	—	$1.3k – $2.8k
25	Regence fee schedule · outpatient · +4 other terms	10	$146	$146	$4	3%	—	$140 – $156

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