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

Nudyn dl or dl mesh pr sq cm

Payers reporting HCPCS Q4285

Payer pricing summary

Low

Average

$166

Median

$163

High

$409

Payer rate distribution

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Filter by billing class

#
1	UnitedHealthcare fee schedule · outpatient · +9 other terms	396	$210	$261	$154	59%	—	$48 – $1.2k
2	Cigna fee schedule · outpatient · +7 other terms	208	$286	$466	$373	80%	—	$119 – $1.5k
3	Aetna fee schedule · outpatient · +8 other terms	176	$144	$199	$196	99%	—	$69 – $1.7k
4	Blue Cross Blue Shield fee schedule · outpatient · +5 other terms	128	$232	$263	$115	44%	—	$1 – $540
5	Humana fee schedule · outpatient · +5 other terms	75	$125	$130	$18	14%	—	$48 – $171
6	Molina fee schedule · outpatient · +5 other terms	50	$192	$255	$397	155%	—	$51 – $3.4k
7	WellCare fee schedule · outpatient · +4 other terms	42	$136	$138	$14	10%	—	$119 – $171
8	Anthem facility · fee schedule · outpatient · +4 other terms	33	$118	$151	$92	61%	—	$48 – $349
9	Devoted fee schedule · outpatient · +3 other terms	32	$125	$124	$7	6%	—	$116 – $136
10	Kaiser fee schedule · outpatient · +3 other terms	32	$207	$291	$205	71%	—	$125 – $1000
11	Optum fee schedule · outpatient · +1 other terms	32	$125	$173	$91	53%	—	$113 – $459
12	Ambetter fee schedule · outpatient · +2 other terms	30	$240	$255	$38	15%	—	$193 – $351
13	Bcbs Tx fee schedule · outpatient	30	$244	$252	$79	31%	—	$186 – $919
14	Caresource fee schedule · outpatient · +2 other terms	23	$100	$92	$64	69%	—	$48 – $199
15	Oscar facility · fee schedule · outpatient · +1 other terms	19	$182	$196	$25	13%	—	$175 – $234
16	Medicare fee schedule · outpatient	18	$125	$125	—	—	—	$125 – $125
17	Highmark fee schedule · outpatient · +4 other terms	16	$187	$233	$324	139%	—	$127 – $3.4k
18	Medical Mutual facility · fee schedule · outpatient · +2 other terms	13	$118	$123	$13	10%	—	$118 – $167
19	Wellmark fee schedule · both · +1 other terms	13	$167	$167	—	—	—	$167 – $167
20	Bcbs Nj fee schedule · outpatient	12	$166	$166	—	—	—	$166 – $166
21	Regence fee schedule · outpatient · +2 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	Medica fee schedule · both · +3 other terms	9	$184	$183	$2	1%	—	$182 – $186
24	Clover facility · fee schedule · outpatient · +1 other terms	8	$123	$123	$6	5%	—	$117 – $134
25	Excellus fee schedule · outpatient · +2 other terms	6	$236	$230	$60	26%	—	$127 – $351

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