Amniotic membrane 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

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

Plano, TX

See all hospitals reporting HCPCS Q4264 →

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Pricing by billing methodology

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How this price compares nationally

Medical City Plano’s median price of $210 is 24% below the median hospital's median price ($275), higher than 38% of the 839 hospitals reporting HCPCS Q4264. The highlighted bar is where this hospital falls; shaded is the middle 50% of hospitals.

Payers reporting HCPCS Q4264 at Medical City Plano

Negotiated rates from the hospital’s own file: 4 payers, 17 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	Blue Cross Blue Shield blueadvantagehmo fee schedule · outpatient	$8	$8	—	—	—	$8 – $8
2	Blue Cross Blue Shield mybluehealth fee schedule · outpatient	$8	$8	—	—	—	$8 – $8
3	Blue Cross Blue Shield bluepremier fee schedule · outpatient	$9	$9	—	—	—	$9 – $9
4	Blue Cross Blue Shield blueessentials fee schedule · outpatient	$10	$10	—	—	—	$10 – $10
5	Blue Cross Blue Shield blueessentialsaccess fee schedule · outpatient	$10	$10	—	—	—	$10 – $10
6	Blue Cross Blue Shield eposoa fee schedule · outpatient	$10	$10	—	—	—	$10 – $10
7	Blue Cross Blue Shield ppo fee schedule · outpatient	$11	$11	—	—	—	$11 – $11
8	UnitedHealthcare allpayerappendix fee schedule · outpatient	$210	$210	—	—	—	$210 – $210
9	UnitedHealthcare narrownetworkindivexchange fee schedule · outpatient	$210	$210	—	—	—	$210 – $210
10	UnitedHealthcare smallgroup fee schedule · outpatient	$210	$210	—	—	—	$210 – $210
11	Humana tricare fee schedule · outpatient	$464	$464	—	—	—	$464 – $464
12	Cigna localplus fee schedule · outpatient	$2.3k	$2.3k	—	—	—	$2.3k – $2.3k
13	Cigna newbusiness fee schedule · outpatient	$2.3k	$2.3k	—	—	—	$2.3k – $2.3k
14	Cigna hmo fee schedule · outpatient	$2.5k	$2.5k	—	—	—	$2.5k – $2.5k
15	Cigna networkbenefit fee schedule · outpatient	$2.5k	$2.5k	—	—	—	$2.5k – $2.5k
16	Cigna openaccessplus fee schedule · outpatient	$2.5k	$2.5k	—	—	—	$2.5k – $2.5k
17	Cigna allother fee schedule · outpatient	$3.2k	$3.2k	—	—	—	$3.2k – $3.2k

Last updated: Mar 1, 2026

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