Grafix Plus skin substitute, 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

Grafix plus, per sq cm

Payers reporting HCPCS Q4304

Payer pricing summary

Low

$91

Average

$541

Median

$444

High

$1.8k

Payer rate distribution

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#
1	UnitedHealthcare fee schedule · outpatient · +9 other terms	426	$296	$752	$912	121%	—	$48 – $6.2k
2	Cigna fee schedule · outpatient · +7 other terms	281	$1.1k	$1.6k	$1.4k	85%	—	$119 – $7.4k
3	Aetna fee schedule · outpatient · +9 other terms	238	$147	$563	$1.0k	182%	—	$69 – $11.0k
4	Blue Cross Blue Shield fee schedule · outpatient · +6 other terms	193	$272	$518	$756	146%	—	$1 – $6.1k
5	Humana fee schedule · outpatient · +7 other terms	182	$731	$606	$956	158%	—	$48 – $5.2k
6	Molina fee schedule · outpatient · +6 other terms	80	$200	$571	$815	143%	—	$51 – $3.4k
7	Caresource fee schedule · outpatient · +3 other terms	61	$738	$445	$513	115%	—	$48 – $1.6k
8	Anthem facility · fee schedule · outpatient · +5 other terms	53	$177	$476	$481	101%	—	$48 – $2.0k
9	WellCare fee schedule · outpatient · +5 other terms	49	$140	$229	$262	115%	—	$115 – $1.2k
10	Ambetter fee schedule · outpatient · +3 other terms	42	$234	$504	$700	139%	—	$162 – $3.2k
11	Kaiser fee schedule · outpatient · +4 other terms	42	$207	$296	$279	94%	—	$125 – $1.9k
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	$239	$247	$77	31%	—	$182 – $901
15	Healthpartners fee schedule · outpatient · +1 other terms	19	$1.1k	$1.1k	$159	15%	—	$131 – $1.1k
16	Oscar facility · fee schedule · outpatient · +2 other terms	19	$234	$363	$259	71%	—	$175 – $761
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	$1.0k	$846	84%	—	$64 – $2.6k
19	Highmark fee schedule · outpatient · +4 other terms	16	$933	$931	$312	34%	—	$127 – $3.4k
20	Wellmark fee schedule · both · +1 other terms	14	$753	$765	$99	13%	—	$614 – $1.4k
21	Bcbs Nj fee schedule · outpatient	11	$829	$822	$187	23%	—	$464 – $920
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	$335	$296	89%	—	$120 – $753
25	Medica fee schedule · both · +3 other terms	9	$984	$982	$9	1%	—	$975 – $994

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