Pellograft tissue matrix, 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

Pellograft, per sq cm

Payers reporting HCPCS Q4320

Payer pricing summary

Low

$68

Average

$326

Median

$169

High

$1.6k

Payer rate distribution

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#
1	UnitedHealthcare fee schedule · outpatient · +9 other terms	403	$273	$703	$867	123%	—	$48 – $5.6k
2	Cigna fee schedule · outpatient · +7 other terms	214	$1.1k	$1.9k	$1.8k	95%	—	$119 – $6.5k
3	Aetna fee schedule · outpatient · +9 other terms	195	$145	$495	$927	187%	—	$69 – $7.8k
4	Blue Cross Blue Shield fee schedule · outpatient · +6 other terms	141	$242	$870	$605	70%	—	$1 – $2.2k
5	Humana fee schedule · outpatient · +6 other terms	76	$125	$129	$17	13%	—	$48 – $171
6	Molina fee schedule · outpatient · +6 other terms	49	$192	$260	$406	156%	—	$51 – $3.4k
7	WellCare fee schedule · outpatient · +5 other terms	43	$136	$139	$14	10%	—	$119 – $171
8	Anthem facility · fee schedule · outpatient · +4 other terms	34	$118	$168	$100	60%	—	$48 – $371
9	Devoted fee schedule · outpatient · +3 other terms	32	$125	$124	$7	6%	—	$116 – $136
10	Kaiser fee schedule · outpatient · +4 other terms	32	$207	$323	$292	90%	—	$125 – $1.6k
11	Optum fee schedule · outpatient · +2 other terms	32	$125	$173	$91	53%	—	$113 – $459
12	Ambetter fee schedule · outpatient · +3 other terms	30	$240	$255	$38	15%	—	$193 – $351
13	Bcbs Tx fee schedule · outpatient	30	$1.0k	$1.0k	$324	31%	—	$765 – $3.8k
14	Caresource fee schedule · outpatient · +3 other terms	25	$100	$97	$62	64%	—	$48 – $199
15	Oscar facility · fee schedule · outpatient · +1 other terms	19	$182	$196	$25	13%	—	$175 – $234
16	Medicare fee schedule · outpatient · +1 other terms	18	$125	$125	—	—	—	$125 – $125
17	Highmark fee schedule · outpatient · +4 other terms	16	$842	$809	$315	39%	—	$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	$720	$721	$6	1%	—	$720 – $756
20	Bcbs Nj fee schedule · outpatient	11	$619	$609	$263	43%	—	$107 – $747
21	Tricare fee schedule · outpatient · +1 other terms	11	$113	$118	$10	8%	—	$113 – $148
22	Regence fee schedule · outpatient · +2 other terms	10	$146	$146	$4	3%	—	$140 – $156
23	Medica fee schedule · both · +3 other terms	9	$794	$791	$7	1%	—	$786 – $801
24	Bcbs Mn fee schedule · both · +2 other terms	8	$772	$771	$7	1%	—	$765 – $779
25	Clover facility · fee schedule · outpatient · +2 other terms	8	$123	$123	$6	5%	—	$117 – $134

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