Vitograft skin graft material, 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

Vitograft, per sq cm

Payers reporting HCPCS Q4317

Payer pricing summary

Low

Average

$918

Median

$327

High

$5.0k

Payer rate distribution

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#
1	UnitedHealthcare fee schedule · outpatient · +10 other terms	265	$210	$1.0k	$2.5k	237%	—	$48 – $8.9k
2	Aetna fee schedule · outpatient · +9 other terms	109	$131	$483	$2.0k	408%	—	$69 – $13.4k
3	Blue Cross Blue Shield fee schedule · outpatient · +7 other terms	101	$14	$43	$63	146%	—	$1 – $361
4	Cigna fee schedule · outpatient · +6 other terms	78	$135	$900	$2.1k	238%	—	$119 – $10.2k
5	Humana fee schedule · outpatient · +8 other terms	70	$125	$127	$15	12%	—	$48 – $171
6	WellCare fee schedule · outpatient · +5 other terms	41	$136	$138	$14	10%	—	$119 – $171
7	Anthem facility · fee schedule · outpatient · +5 other terms	34	$118	$1.9k	$4.6k	239%	—	$48 – $17.2k
8	Molina facility · fee schedule · outpatient · +7 other terms	34	$118	$129	$50	39%	—	$65 – $319
9	Devoted fee schedule · outpatient · +3 other terms	31	$125	$124	$7	6%	—	$116 – $136
10	Ambetter fee schedule · outpatient · +3 other terms	30	$240	$255	$38	15%	—	$193 – $351
11	Bcbs Tx fee schedule · outpatient	30	$8	$8	$3	31%	—	$6 – $30
12	Kaiser fee schedule · outpatient · +4 other terms	27	$207	$281	$217	77%	—	$125 – $1000
13	Optum fee schedule · outpatient · +2 other terms	24	$125	$149	$94	63%	—	$113 – $459
14	Medicare fee schedule · outpatient · +1 other terms	18	$125	$125	—	—	—	$125 – $125
15	Caresource fee schedule · outpatient · +5 other terms	17	$100	$87	$57	65%	—	$48 – $199
16	Medical Mutual facility · fee schedule · outpatient · +1 other terms	13	$118	$123	$13	10%	—	$118 – $167
17	Bcbs Nj fee schedule · outpatient	11	$5.0k	$5.0k	—	—	—	$5.0k – $5.0k
18	Highmark facility · other · outpatient · +5 other terms	11	$132	$126	$20	16%	—	$82 – $171
19	Oscar facility · fee schedule · outpatient · +1 other terms	11	$175	$177	$3	2%	—	$175 – $182
20	Regence fee schedule · outpatient · +2 other terms	10	$146	$146	$4	3%	—	$140 – $156
21	Tricare fee schedule · outpatient · +1 other terms	10	$113	$115	$4	3%	—	$113 – $121
22	Excellus fee schedule · outpatient · +2 other terms	6	$236	$230	$60	26%	—	$127 – $351
23	Aetna Better Health facility · fee schedule · outpatient · +1 other terms	5	$68	$68	$1	1%	—	$68 – $70
24	Clover fee schedule · outpatient · +1 other terms	5	$120	$125	$9	7%	—	$120 – $140
25	First Health professional · fee schedule · both · +2 other terms	3	$5.3k	$5.3k	—	—	—	$5.3k – $5.3k

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