Surgraft tissue 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

Surgraft xt per sq cm

Payers reporting HCPCS Q4269

Payer pricing summary

Low

Average

$825

Median

$461

High

$4.3k

Payer rate distribution

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#
1	UnitedHealthcare fee schedule · outpatient · +9 other terms	401	$296	$1.3k	$2.4k	184%	—	$48 – $17.9k
2	Cigna fee schedule · outpatient · +7 other terms	229	$2.2k	$5.1k	$5.5k	108%	—	$119 – $19.6k
3	Aetna fee schedule · outpatient · +8 other terms	196	$145	$640	$1.3k	200%	—	$69 – $8.6k
4	Humana fee schedule · outpatient · +6 other terms	167	$171	$1.3k	$1.3k	104%	—	$48 – $3.0k
5	Blue Cross Blue Shield fee schedule · outpatient · +6 other terms	164	$124	$267	$874	328%	—	$1 – $5.2k
6	Molina fee schedule · outpatient · +6 other terms	54	$192	$254	$395	156%	—	$51 – $3.4k
7	Anthem facility · fee schedule · outpatient · +4 other terms	52	$177	$1.4k	$1.9k	137%	—	$48 – $7.6k
8	WellCare fee schedule · outpatient · +5 other terms	46	$138	$375	$768	205%	—	$119 – $2.9k
9	Caresource fee schedule · outpatient · +3 other terms	41	$190	$720	$1.2k	161%	—	$48 – $2.9k
10	Kaiser fee schedule · outpatient · +4 other terms	41	$207	$292	$252	86%	—	$125 – $1.6k
11	Ambetter fee schedule · outpatient · +3 other terms	37	$247	$854	$1.7k	204%	—	$162 – $5.9k
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	Oscar facility · fee schedule · outpatient · +1 other terms	19	$182	$196	$25	13%	—	$175 – $234
16	Medicare fee schedule · outpatient · +1 other terms	18	$125	$125	—	—	—	$125 – $125
17	Highmark fee schedule · outpatient · +4 other terms	16	$3.5k	$3.2k	$890	27%	—	$127 – $3.6k
18	Medical Mutual facility · fee schedule · outpatient · +2 other terms	16	$133	$5.0k	$4.3k	86%	—	$118 – $12.2k
19	Wellmark fee schedule · both · +1 other terms	13	$123	$123	—	—	—	$123 – $123
20	Bcbs Nj fee schedule · outpatient	11	$972	$990	$463	47%	—	$747 – $1.9k
21	Regence fee schedule · outpatient · +4 other terms	10	$146	$146	$4	3%	—	$140 – $156
22	Tricare fee schedule · outpatient · +1 other terms	10	$113	$115	$4	3%	—	$113 – $121
23	Clover fee schedule · outpatient · +2 other terms	9	$140	$1.0k	$1.3k	124%	—	$120 – $2.9k
24	Medica fee schedule · both · +3 other terms	9	$794	$791	$7	1%	—	$786 – $801
25	Excellus fee schedule · outpatient · +2 other terms	6	$236	$230	$60	26%	—	$127 – $351

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