Grafix duo wound 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

Grafix duo per sq cm

Payers reporting HCPCS Q4392

Payer pricing summary

Low

$68

Average

$178

Median

$147

High

$803

Payer rate distribution

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#
1	UnitedHealthcare fee schedule · outpatient · +7 other terms	220	$210	$225	$74	33%	—	$30 – $483
2	Aetna fee schedule · outpatient · +7 other terms	59	$132	$142	$44	31%	—	$69 – $444
3	Blue Cross Blue Shield fee schedule · outpatient · +4 other terms	42	$269	$300	$120	40%	—	$30 – $530
4	Humana fee schedule · outpatient · +6 other terms	42	$127	$134	$14	10%	—	$121 – $171
5	Molina facility · fee schedule · outpatient · +5 other terms	33	$118	$129	$51	39%	—	$65 – $319
6	Cigna fee schedule · outpatient · +3 other terms	30	$206	$258	$175	68%	—	$91 – $644
7	WellCare fee schedule · outpatient · +5 other terms	30	$140	$135	$29	22%	—	$30 – $158
8	Anthem facility · fee schedule · outpatient · +5 other terms	23	$127	$179	$84	47%	—	$49 – $349
9	Devoted facility · fee schedule · outpatient · +3 other terms	23	$118	$124	$11	9%	—	$118 – $143
10	Kaiser fee schedule · outpatient · +2 other terms	22	$125	$307	$247	80%	—	$125 – $1000
11	Ambetter fee schedule · outpatient · +2 other terms	18	$256	$263	$41	16%	—	$218 – $351
12	Medicare fee schedule · outpatient	18	$125	$125	—	—	—	$125 – $125
13	Caresource fee schedule · outpatient · +2 other terms	14	$58	$79	$57	73%	—	$51 – $199
14	Medical Mutual facility · fee schedule · outpatient · +1 other terms	12	$118	$123	$13	11%	—	$118 – $167
15	Optum fee schedule · outpatient	12	$125	$180	$125	69%	—	$125 – $459
16	Regence fee schedule · outpatient · +2 other terms	9	$146	$145	$3	2%	—	$140 – $150
17	Excellus fee schedule · outpatient · +2 other terms	6	$236	$230	$60	26%	—	$127 – $351
18	Aetna Better Health facility · fee schedule · outpatient	5	$68	$68	$1	1%	—	$68 – $70
19	Highmark fee schedule · outpatient · +3 other terms	5	$155	$179	$57	32%	—	$127 – $279
20	Tricare facility · fee schedule · outpatient	4	$121	$118	$5	4%	—	$109 – $121
21	First Health professional · fee schedule · both	3	$122	$122	—	—	—	$122 – $122
22	Bcbs Al facility · case rate · outpatient	2	$125	$125	—	—	—	$125 – $125
23	Bcbs Id fee schedule · outpatient	2	$140	$140	—	—	—	$140 – $140
24	Bcbs Ks fee schedule · outpatient	2	$125	$125	—	—	—	$125 – $125
25	Bcbs Mi facility · case rate · outpatient · +1 other terms	2	$66	$66	—	—	—	$66 – $66

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