Skin substitute product, not otherwise specified

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

BONE ACELLULAR DERM MATRIX 2X4CM 0.4-1.0MM ALLOMEND-COST PER SQ CM-8SQ CM

Payers reporting HCPCS Q4433

Payer pricing summary

Low

$66

Average

$2.1k

Median

$1.0k

High

$13.6k

Payer rate distribution

Filter by billing methodology

Filter by billing class

#
1	UnitedHealthcare fee schedule · outpatient · +16 other terms	218	$210	$263	$159	60%	—	$1 – $1.2k
2	Aetna facility · fee schedule · outpatient · +18 other terms	87	$125	$126	$4	3%	—	$112 – $160
3	Humana facility · fee schedule · outpatient · +15 other terms	77	$125	$125	$3	2%	—	$109 – $154
4	Blue Cross Blue Shield facility · fee schedule · outpatient · +17 other terms	64	$131	$131	$24	18%	—	$0 – $617
5	Molina facility · fee schedule · outpatient · +11 other terms	43	$125	$133	$28	21%	—	$65 – $360
6	Ambetter facility · fee schedule · outpatient · +10 other terms	37	$224	$267	$15	5%	—	$158 – $331
7	Devoted facility · fee schedule · outpatient · +8 other terms	36	$118	$126	$9	7%	—	$111 – $143
8	WellCare facility · fee schedule · outpatient · +11 other terms	36	$126	$131	$29	22%	—	$113 – $286
9	Cigna facility · fee schedule · outpatient · +16 other terms	33	$121	$167	$104	63%	—	$118 – $659
10	Tricare facility · fee schedule · outpatient · +3 other terms	30	$127	$129	$6	5%	—	$121 – $147
11	Kaiser fee schedule · outpatient · +10 other terms	28	$349	$2.1k	$5.6k	263%	—	$125 – $41.2k
12	Anthem facility · fee schedule · outpatient · +10 other terms	25	$127	$263	$161	61%	—	$118 – $537
13	Baylor Scott White Health Plan facility · fee schedule · outpatient · +2 other terms	25	$158	$158	$31	20%	—	$119 – $207
14	Superior Healthplan facility · fee schedule · outpatient · +3 other terms	23	$131	$129	$5	4%	—	$23 – $131
15	Medicare fee schedule · outpatient · +2 other terms	19	$125	$125	$3	2%	—	$123 – $139
16	Caresource facility · fee schedule · outpatient · +6 other terms	17	$212	$194	$38	20%	—	$121 – $238
17	Beechstreet percent of total billed charges · bothfrom % of charges · +1 other terms	15	$14.9k	$13.8k	$15.7k	114%	—	$6 – $96.1k
18	Medcost facility · percent of total billed charges · bothfrom % of charges · +1 other terms	14	$202	$225	$573	255%	—	$45 – $8.4k
19	Medicaid fee schedule · outpatient · +4 other terms	13	$13.2k	$13.2k	$10.1k	77%	—	$1 – $41.2k
20	Medical Mutual facility · fee schedule · outpatient · +4 other terms	12	$118	$119	$3	3%	—	$118 – $127
21	Optum fee schedule · outpatient · +8 other terms	12	$125	$180	$125	69%	—	$125 – $459
22	Amerihealth Caritas facility · percent of total billed charges · bothfrom % of charges · +2 other terms	11	$369	$354	$1.2k	340%	—	$24 – $18k
23	Regence fee schedule · outpatient · +5 other terms	9	$146	$145	$3	2%	—	$140 – $150
24	MultiPlan other · both · +7 other terms	8	$134	$134	$0	0%	—	$134 – $134
25	Oscar other · both · +3 other terms	8	$163	$163	$0	0%	—	$163 – $163

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