Alloskin tissue graft, per square centimeter at Medical City Plano

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

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

Plano, TX

See all hospitals reporting HCPCS Q4115 →

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Pricing by billing methodology

Price type

How this price compares nationally

Medical City Plano’s median price of $83 is about the same as the median hospital's median price ($83), higher than 50% of the 1,027 hospitals reporting HCPCS Q4115. The highlighted bar is where this hospital falls; shaded is the middle 50% of hospitals.

Payers reporting HCPCS Q4115 at Medical City Plano

Negotiated rates from the hospital’s own file: 4 payers, 18 plan rates. A facility fee, a professional fee, a per diem and a case rate are different bills, so each is listed on its own. Open a payer to see it across hospitals.

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#
1	Humana tricare fee schedule · outpatient	$12	$12	—	—	—	$12 – $12
2	Blue Cross Blue Shield bluepremier fee schedule · outpatient	$50	$50	—	—	—	$50 – $50
3	Blue Cross Blue Shield blueadvantagehmo fee schedule · outpatient	$52	$52	—	—	—	$52 – $52
4	Blue Cross Blue Shield mybluehealth fee schedule · outpatient	$52	$52	—	—	—	$52 – $52
5	Blue Cross Blue Shield blueessentials fee schedule · outpatient	$76	$76	—	—	—	$76 – $76
6	Blue Cross Blue Shield blueessentialsaccess fee schedule · outpatient	$76	$76	—	—	—	$76 – $76
7	Blue Cross Blue Shield eposoa fee schedule · outpatient	$80	$80	—	—	—	$80 – $80
8	Humana comm fee schedule · outpatient	$80	$80	—	—	—	$80 – $80
9	Blue Cross Blue Shield ppo fee schedule · outpatient	$83	$83	—	—	—	$83 – $83
10	Cigna localplus fee schedule · outpatient	$88	$88	—	—	—	$88 – $88
11	Cigna newbusiness fee schedule · outpatient	$88	$88	—	—	—	$88 – $88
12	Cigna hmo fee schedule · outpatient	$98	$98	—	—	—	$98 – $98
13	Cigna networkbenefit fee schedule · outpatient	$98	$98	—	—	—	$98 – $98
14	Cigna openaccessplus fee schedule · outpatient	$98	$98	—	—	—	$98 – $98
15	Cigna allother fee schedule · outpatient	$124	$124	—	—	—	$124 – $124
16	UnitedHealthcare allpayerappendix fee schedule · outpatient	$210	$210	—	—	—	$210 – $210
17	UnitedHealthcare narrownetworkindivexchange fee schedule · outpatient	$210	$210	—	—	—	$210 – $210
18	UnitedHealthcare smallgroup fee schedule · outpatient	$210	$210	—	—	—	$210 – $210

Last updated: Mar 1, 2026

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