Skin substitute matrix application, 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

Activate matrix, per sq cm

Payers reporting HCPCS Q4301

Payer pricing summary

Low

Average

$1.0k

Median

$788

High

$3.9k

Payer rate distribution

Filter by billing methodology

Filter by billing class

#
1	UnitedHealthcare fee schedule · outpatient · +9 other terms	419	$296	$1.6k	$2.2k	141%	—	$48 – $11.9k
2	Cigna fee schedule · outpatient · +7 other terms	273	$2.9k	$4.3k	$4.0k	92%	—	$119 – $15.4k
3	Aetna fee schedule · outpatient · +9 other terms	226	$146	$1.1k	$2.4k	215%	—	$69 – $23.1k
4	Blue Cross Blue Shield fee schedule · outpatient · +6 other terms	181	$127	$554	$1.3k	226%	—	$1 – $7.6k
5	Humana fee schedule · outpatient · +6 other terms	170	$168	$853	$846	99%	—	$48 – $2.0k
6	Molina fee schedule · outpatient · +6 other terms	76	$201	$1.0k	$1.7k	171%	—	$51 – $4.7k
7	Caresource fee schedule · outpatient · +3 other terms	61	$1.7k	$969	$1.2k	126%	—	$48 – $3.3k
8	Anthem facility · fee schedule · outpatient · +5 other terms	53	$177	$1.1k	$1.5k	138%	—	$48 – $6.5k
9	WellCare fee schedule · outpatient · +5 other terms	49	$140	$369	$643	174%	—	$115 – $2.5k
10	Kaiser fee schedule · outpatient · +4 other terms	41	$207	$334	$526	158%	—	$125 – $4.1k
11	Ambetter fee schedule · outpatient · +3 other terms	38	$248	$668	$1.1k	169%	—	$162 – $3.9k
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	Healthpartners fee schedule · outpatient · +1 other terms	19	$2.8k	$2.8k	$445	16%	—	$131 – $2.9k
16	Oscar facility · fee schedule · outpatient · +2 other terms	19	$234	$801	$934	116%	—	$175 – $2.2k
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	$2.8k	$2.6k	92%	—	$64 – $7.7k
19	Highmark fee schedule · outpatient · +4 other terms	16	$2.3k	$2.2k	$561	25%	—	$127 – $3.4k
20	Wellmark fee schedule · both · +1 other terms	14	$1.9k	$1.9k	$14	1%	—	$1.8k – $1.9k
21	Bcbs Nj fee schedule · outpatient	11	$1.9k	$1.9k	$28	1%	—	$1.9k – $1.9k
22	Tricare fee schedule · outpatient · +1 other terms	11	$113	$118	$10	8%	—	$113 – $148
23	Regence fee schedule · outpatient · +3 other terms	10	$146	$146	$4	3%	—	$140 – $156
24	Clover fee schedule · outpatient · +2 other terms	9	$140	$716	$835	117%	—	$120 – $1.9k
25	Medica fee schedule · both · +3 other terms	9	$2.1k	$2.1k	$18	1%	—	$2.1k – $2.1k

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