Skin graft matrix sheet, 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

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

Payers reporting HCPCS Q4352

Payer pricing summary

Low

Average

$559

Median

$148

High

$4.4k

Payer rate distribution

Filter by billing methodology

Filter by billing class

#
1	UnitedHealthcare fee schedule · outpatient · +9 other terms	380	$296	$1.6k	$2.4k	147%	—	$51 – $14.6k
2	Cigna fee schedule · outpatient · +7 other terms	178	$2.7k	$5.1k	$5.1k	100%	—	$119 – $17.0k
3	Aetna fee schedule · outpatient · +8 other terms	155	$132	$695	$1.7k	251%	—	$69 – $8.6k
4	Blue Cross Blue Shield fee schedule · outpatient · +5 other terms	124	$232	$1.9k	$1.4k	74%	—	$1 – $4.9k
5	Humana fee schedule · outpatient · +5 other terms	73	$125	$129	$15	12%	—	$116 – $171
6	Molina fee schedule · outpatient · +5 other terms	47	$193	$264	$410	155%	—	$92 – $3.4k
7	WellCare fee schedule · outpatient · +4 other terms	42	$136	$138	$14	10%	—	$119 – $171
8	Anthem facility · fee schedule · outpatient · +4 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	$389	$648	166%	—	$125 – $4.2k
11	Optum fee schedule · outpatient · +1 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	$2.2k	$2.3k	$707	31%	—	$1.7k – $8.3k
14	Caresource facility · fee schedule · outpatient · +2 other terms	22	$202	$189	$48	25%	—	$121 – $248
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	$2.2k	$2.1k	$510	25%	—	$127 – $3.4k
18	Medical Mutual facility · fee schedule · outpatient · +2 other terms	13	$118	$123	$13	10%	—	$118 – $167
19	Bcbs Nj fee schedule · outpatient	12	$1.9k	$1.9k	—	—	—	$1.9k – $1.9k
20	Regence fee schedule · outpatient · +4 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	Medica fee schedule · both · +3 other terms	9	$2.1k	$2.1k	$19	1%	—	$2.1k – $2.2k
23	Excellus fee schedule · outpatient · +2 other terms	6	$236	$230	$60	26%	—	$127 – $351
24	Aetna Better Health facility · fee schedule · outpatient	5	$68	$68	$1	1%	—	$68 – $70
25	Clover fee schedule · outpatient · +1 other terms	5	$120	$125	$9	7%	—	$120 – $140

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