Amniotic membrane 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

Amniotx, per square centimeter (add-on, list separately in addition to primary procedure)

Payers reporting HCPCS Q4324

Payer pricing summary

Low

Average

$586

Median

$186

High

$3.6k

Payer rate distribution

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#
1	UnitedHealthcare fee schedule · outpatient · +9 other terms	382	$296	$1.4k	$1.9k	144%	—	$48 – $12.1k
2	Cigna fee schedule · outpatient · +8 other terms	195	$2.5k	$4.2k	$4.1k	96%	—	$119 – $14.4k
3	Aetna fee schedule · outpatient · +8 other terms	176	$144	$933	$2.2k	240%	—	$69 – $17.2k
4	Blue Cross Blue Shield fee schedule · outpatient · +5 other terms	126	$120	$66	$141	215%	—	$1 – $1.8k
5	Humana fee schedule · outpatient · +6 other terms	74	$125	$128	$17	13%	—	$48 – $171
6	Molina fee schedule · outpatient · +5 other terms	49	$192	$260	$406	156%	—	$51 – $3.4k
7	WellCare fee schedule · outpatient · +4 other terms	42	$136	$138	$14	10%	—	$119 – $171
8	Anthem facility · fee schedule · outpatient · +3 other terms	32	$118	$153	$91	60%	—	$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	$373	$552	148%	—	$125 – $3.5k
11	Optum fee schedule · outpatient · +2 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	$6	$7	$2	31%	—	$5 – $24
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	$1.9k	$1.8k	$435	25%	—	$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	$1.6k	$1.6k	—	—	—	$1.6k – $1.6k
20	Bcbs Nj fee schedule · outpatient	12	$1.6k	$1.6k	—	—	—	$1.6k – $1.6k
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	$1.8k	$1.8k	$16	1%	—	$1.8k – $1.8k
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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