Palingen dual-layer membrane 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

Palingen dual-layer membrane and dual-layer palingen x-membrane, per square centimeter (add-on, list separately in addition to primary procedure)

Payers reporting HCPCS Q4354

Payer pricing summary

Low

$68

Average

$495

Median

$156

High

$2.9k

Payer rate distribution

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#
1	UnitedHealthcare fee schedule · outpatient · +10 other terms	297	$210	$585	$1.1k	195%	—	$51 – $7.7k
2	Cigna fee schedule · outpatient · +8 other terms	146	$1.9k	$2.9k	$2.8k	94%	—	$119 – $9.1k
3	Aetna fee schedule · outpatient · +9 other terms	135	$132	$389	$1.6k	410%	—	$69 – $12.6k
4	Blue Cross Blue Shield fee schedule · outpatient · +5 other terms	119	$119	$58	$80	139%	—	$1 – $431
5	Humana fee schedule · outpatient · +5 other terms	73	$125	$130	$14	11%	—	$116 – $171
6	WellCare fee schedule · outpatient · +6 other terms	41	$136	$138	$13	9%	—	$119 – $171
7	Molina fee schedule · outpatient · +5 other terms	39	$192	$275	$444	162%	—	$118 – $3.4k
8	Devoted fee schedule · outpatient · +3 other terms	32	$125	$124	$7	6%	—	$116 – $136
9	Optum fee schedule · outpatient · +2 other terms	32	$125	$173	$91	53%	—	$113 – $459
10	Ambetter fee schedule · outpatient · +2 other terms	30	$240	$249	$37	15%	—	$193 – $351
11	Kaiser fee schedule · outpatient · +3 other terms	28	$207	$285	$214	75%	—	$125 – $1000
12	Anthem fee schedule · outpatient · +4 other terms	23	$155	$294	$305	103%	—	$123 – $911
13	Caresource fee schedule · outpatient · +2 other terms	20	$100	$92	$65	70%	—	$51 – $199
14	Medicare fee schedule · outpatient	18	$125	$125	—	—	—	$125 – $125
15	Highmark fee schedule · outpatient · +4 other terms	16	$1.1k	$1.2k	$675	56%	—	$127 – $4.7k
16	Medical Mutual facility · fee schedule · outpatient · +1 other terms	13	$118	$123	$13	10%	—	$118 – $167
17	Oscar facility · fee schedule · outpatient · +1 other terms	11	$175	$177	$3	2%	—	$175 – $182
18	Regence fee schedule · outpatient · +4 other terms	10	$146	$146	$4	3%	—	$140 – $156
19	Tricare fee schedule · outpatient · +1 other terms	10	$113	$115	$4	3%	—	$113 – $121
20	Excellus fee schedule · outpatient · +2 other terms	6	$236	$230	$60	26%	—	$127 – $351
21	Aetna Better Health facility · fee schedule · outpatient	5	$68	$68	$1	1%	—	$68 – $70
22	Clover fee schedule · outpatient · +1 other terms	5	$120	$125	$9	7%	—	$120 – $140
23	First Health professional · fee schedule · both · +1 other terms	3	$4.7k	$4.7k	—	—	—	$4.7k – $4.7k
24	Bcbs Al facility · case rate · outpatient	2	$125	$125	—	—	—	$125 – $125
25	Bcbs Id fee schedule · outpatient	2	$140	$140	—	—	—	$140 – $140

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