Amniotic membrane allograft add-on 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

Esano ac, per sq cm

Payers reporting HCPCS Q4274

Payer pricing summary

Low

Average

$1.8k

Median

$769

High

$38.7k

Payer rate distribution

Filter by billing methodology

Filter by billing class

#
1	UnitedHealthcare fee schedule · outpatient · +9 other terms	423	$296	$1.4k	$1.9k	133%	—	$48 – $11.5k
2	Cigna fee schedule · outpatient · +8 other terms	264	$2.5k	$4.0k	$4.1k	102%	—	$119 – $15.7k
3	Aetna fee schedule · outpatient · +10 other terms	221	$146	$1.1k	$2.2k	210%	—	$69 – $18.5k
4	Humana fee schedule · outpatient · +7 other terms	184	$1.2k	$990	$1.1k	108%	—	$48 – $4.8k
5	Blue Cross Blue Shield fee schedule · outpatient · +7 other terms	175	$125	$319	$716	224%	—	$1 – $3.3k
6	Molina fee schedule · outpatient · +6 other terms	56	$192	$251	$389	155%	—	$51 – $3.4k
7	Anthem facility · fee schedule · outpatient · +5 other terms	52	$177	$1.1k	$1.6k	145%	—	$48 – $6.8k
8	WellCare fee schedule · outpatient · +6 other terms	50	$140	$275	$461	168%	—	$115 – $1.8k
9	Caresource fee schedule · outpatient · +3 other terms	49	$191	$659	$918	139%	—	$48 – $3.1k
10	Kaiser fee schedule · outpatient · +4 other terms	41	$207	$330	$495	150%	—	$125 – $3.8k
11	Ambetter fee schedule · outpatient · +3 other terms	38	$248	$656	$1.1k	167%	—	$162 – $3.8k
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	$162	$161	$6	4%	—	$131 – $166
16	Oscar facility · fee schedule · outpatient · +1 other terms	19	$234	$811	$948	117%	—	$175 – $2.3k
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	$2.9k	$2.7k	92%	—	$64 – $7.8k
19	Highmark fee schedule · outpatient · +4 other terms	16	$2.3k	$2.1k	$532	25%	—	$127 – $3.4k
20	Wellmark fee schedule · both · +1 other terms	14	$1.8k	$1.8k	$85	5%	—	$1.2k – $1.8k
21	Bcbs Nj fee schedule · outpatient	11	$1.8k	$1.8k	$76	4%	—	$1.8k – $2.0k
22	Tricare fee schedule · outpatient · +1 other terms	11	$113	$118	$10	8%	—	$113 – $148
23	Regence fee schedule · outpatient · +2 other terms	10	$146	$146	$4	3%	—	$140 – $156
24	Clover fee schedule · outpatient · +2 other terms	9	$140	$696	$808	116%	—	$120 – $1.8k
25	Medica fee schedule · both · +3 other terms	9	$2.0k	$2.0k	$17	1%	—	$1.9k – $2.0k

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