Wound matrix dressing, 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

Resolve matrix per sq cm

Payers reporting HCPCS A2024

Payer pricing summary

Low

Average

$376

Median

$171

High

$3.2k

Payer rate distribution

Filter by billing methodology

Filter by billing class

#
1	UnitedHealthcare fee schedule · outpatient · +9 other terms	396	$296	$1.5k	$2.0k	136%	—	$48 – $12.1k
2	Aetna fee schedule · outpatient · +8 other terms	168	$135	$632	$1.4k	215%	—	$69 – $13.9k
3	Blue Cross Blue Shield fee schedule · outpatient · +5 other terms	125	$119	$227	$912	402%	—	$1 – $7.6k
4	Humana fee schedule · outpatient · +6 other terms	81	$125	$357	$1.1k	304%	—	$48 – $7.3k
5	Cigna fee schedule · outpatient · +5 other terms	69	$129	$193	$319	165%	—	$119 – $3.7k
6	Molina fee schedule · outpatient · +5 other terms	47	$192	$261	$411	157%	—	$51 – $3.4k
7	WellCare fee schedule · outpatient · +4 other terms	43	$136	$138	$13	9%	—	$119 – $171
8	Anthem facility · fee schedule · outpatient · +4 other terms	33	$118	$151	$92	61%	—	$48 – $349
9	Devoted fee schedule · outpatient · +3 other terms	33	$125	$125	$7	6%	—	$116 – $139
10	Optum fee schedule · outpatient · +1 other terms	32	$125	$173	$91	53%	—	$113 – $459
11	Ambetter fee schedule · outpatient · +2 other terms	30	$240	$249	$37	15%	—	$193 – $351
12	Bcbs Tx fee schedule · outpatient	30	$11	$11	$3	31%	—	$8 – $40
13	Kaiser fee schedule · outpatient · +3 other terms	30	$207	$287	$210	73%	—	$125 – $1000
14	Caresource fee schedule · outpatient · +2 other terms	22	$100	$90	$64	71%	—	$48 – $199
15	Medicare fee schedule · outpatient	18	$125	$125	—	—	—	$125 – $125
16	Medical Mutual facility · fee schedule · outpatient · +1 other terms	13	$118	$123	$13	10%	—	$118 – $167
17	Oscar facility · fee schedule · outpatient · +1 other terms	11	$175	$177	$3	2%	—	$175 – $182
18	Regence fee schedule · outpatient · +2 other terms	10	$146	$146	$4	3%	—	$140 – $156
19	Tricare fee schedule · outpatient · +1 other terms	10	$113	$115	$4	3%	—	$113 – $121
20	Medica fee schedule · both · +3 other terms	9	$2.1k	$2.1k	$19	1%	—	$2.1k – $2.1k
21	Aetna Better Health fee schedule · inpatient · +2 other terms	7	$919	$919	—	—	—	$919 – $919
22	Excellus fee schedule · outpatient · +2 other terms	6	$236	$230	$60	26%	—	$127 – $351
23	Highmark fee schedule · outpatient · +3 other terms	6	$176	$708	$979	138%	—	$127 – $3.4k
24	Bcbs Mn fee schedule · outpatient	5	$1	$1	$0	66%	—	$0 – $1
25	Clover fee schedule · outpatient · +1 other terms	5	$120	$125	$9	7%	—	$120 – $140

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