Wound dressing matrix, 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

Neomatrix per sq cm

Payers reporting HCPCS A2021

Payer pricing summary

Low

Average

$632

Median

$189

High

$3.7k

Payer rate distribution

Filter by billing methodology

Filter by billing class

#
1	UnitedHealthcare fee schedule · outpatient · +10 other terms	401	$296	$1.1k	$1.4k	125%	—	$48 – $8.4k
2	Cigna fee schedule · outpatient · +10 other terms	219	$2.4k	$4.3k	$4.1k	96%	—	$7 – $15.0k
3	Aetna fee schedule · outpatient · +13 other terms	201	$146	$1.1k	$2.2k	208%	—	$69 – $17.9k
4	Blue Cross Blue Shield fee schedule · outpatient · +4 other terms	137	$121	$210	$667	318%	—	$1 – $5.3k
5	Humana fee schedule · outpatient · +8 other terms	85	$125	$339	$813	240%	—	$48 – $5.0k
6	Molina fee schedule · outpatient · +5 other terms	48	$192	$261	$408	156%	—	$51 – $3.4k
7	WellCare fee schedule · outpatient · +5 other terms	46	$136	$138	$14	10%	—	$115 – $171
8	Ambetter fee schedule · outpatient · +2 other terms	33	$234	$246	$45	18%	—	$162 – $351
9	Anthem facility · fee schedule · outpatient · +4 other terms	33	$118	$151	$92	61%	—	$48 – $349
10	Devoted fee schedule · outpatient · +3 other terms	33	$125	$125	$7	6%	—	$116 – $139
11	Kaiser fee schedule · outpatient · +3 other terms	32	$207	$377	$576	153%	—	$125 – $3.7k
12	Optum fee schedule · outpatient · +1 other terms	32	$125	$173	$91	53%	—	$113 – $459
13	Bcbs Tx fee schedule · outpatient	30	$11	$11	$3	31%	—	$8 – $40
14	Caresource fee schedule · outpatient · +2 other terms	24	$100	$94	$65	69%	—	$48 – $213
15	Oscar facility · fee schedule · outpatient · +1 other terms	19	$182	$196	$25	13%	—	$175 – $234
16	Medicare fee schedule · outpatient	18	$125	$125	—	—	—	$125 – $125
17	Highmark fee schedule · outpatient · +4 other terms	16	$1.9k	$1.8k	$453	25%	—	$127 – $3.4k
18	Medical Mutual facility · fee schedule · outpatient · +2 other terms	14	$118	$150	$96	64%	—	$64 – $468
19	Bcbs Nj fee schedule · outpatient	12	$1.7k	$1.7k	—	—	—	$1.7k – $1.7k
20	Medica fee schedule · outpatient · +4 other terms	10	$1.1k	$1.1k	$286	25%	—	$689 – $1.5k
21	Regence fee schedule · outpatient · +4 other terms	10	$146	$146	$4	3%	—	$140 – $156
22	Tricare fee schedule · outpatient · +1 other terms	10	$113	$115	$4	3%	—	$113 – $121
23	Clover facility · fee schedule · outpatient · +1 other terms	8	$123	$123	$6	5%	—	$117 – $134
24	Aetna Better Health fee schedule · inpatient · +2 other terms	7	$1.7k	$1.7k	—	—	—	$1.7k – $1.7k
25	Excellus fee schedule · outpatient · +2 other terms	6	$236	$230	$60	26%	—	$127 – $351

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