Surgical graft tissue, 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 ft per sq cm

Payers reporting HCPCS Q4268

Payer pricing summary

Low

Average

$613

Median

$304

High

$2.7k

Payer rate distribution

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#
1	UnitedHealthcare fee schedule · outpatient · +9 other terms	420	$296	$1.0k	$1.3k	125%	—	$48 – $8.2k
2	Cigna fee schedule · outpatient · +7 other terms	236	$1.6k	$2.8k	$2.9k	103%	—	$119 – $10.6k
3	Aetna fee schedule · outpatient · +9 other terms	219	$146	$578	$1.1k	198%	—	$69 – $11.4k
4	Blue Cross Blue Shield fee schedule · outpatient · +6 other terms	167	$123	$223	$761	341%	—	$1 – $6.4k
5	Humana fee schedule · outpatient · +7 other terms	94	$125	$435	$879	202%	—	$48 – $3.7k
6	Molina fee schedule · outpatient · +6 other terms	52	$192	$258	$407	158%	—	$51 – $3.4k
7	WellCare fee schedule · outpatient · +5 other terms	44	$136	$174	$171	98%	—	$115 – $974
8	Kaiser fee schedule · outpatient · +4 other terms	40	$207	$304	$333	109%	—	$125 – $2.3k
9	Ambetter fee schedule · outpatient · +3 other terms	37	$234	$398	$668	168%	—	$162 – $3.3k
10	Anthem facility · fee schedule · outpatient · +4 other terms	36	$118	$407	$613	151%	—	$48 – $2.4k
11	Devoted fee schedule · outpatient · +3 other terms	33	$125	$125	$7	6%	—	$116 – $136
12	Optum fee schedule · outpatient · +2 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 · +3 other terms	26	$100	$99	$63	64%	—	$48 – $213
15	Healthpartners fee schedule · outpatient · +1 other terms	19	$1.1k	$1.1k	$158	15%	—	$131 – $1.1k
16	Oscar facility · fee schedule · outpatient · +2 other terms	19	$182	$196	$25	13%	—	$175 – $234
17	Medicare fee schedule · outpatient · +1 other terms	18	$125	$125	—	—	—	$125 – $125
18	Highmark fee schedule · outpatient · +4 other terms	16	$1.2k	$1.3k	$844	64%	—	$127 – $5.9k
19	Medical Mutual facility · fee schedule · outpatient · +2 other terms	14	$118	$150	$96	64%	—	$64 – $468
20	Wellmark fee schedule · both · +1 other terms	13	$141	$175	$209	120%	—	$141 – $1.4k
21	Bcbs Nj fee schedule · outpatient	11	$965	$956	$255	27%	—	$470 – $1.1k
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	$499	25%	—	$1.2k – $2.6k
24	Regence fee schedule · outpatient · +4 other terms	10	$146	$146	$4	3%	—	$140 – $156
25	Clover facility · fee schedule · outpatient · +2 other terms	8	$123	$123	$6	5%	—	$117 – $134

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