Wound matrix sheet, per cubic 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

Mirotract matrix sheet

Payers reporting HCPCS A2029

Payer pricing summary

Low

$68

Average

$413

Median

$212

High

$4.5k

Payer rate distribution

Filter by billing methodology

Filter by billing class

#
1	UnitedHealthcare fee schedule · outpatient · +12 other terms	262	$210	$294	$211	72%	—	$48 – $845
2	Cigna fee schedule · outpatient · +11 other terms	187	$638	$1.2k	$995	86%	—	$119 – $3.6k
3	Aetna fee schedule · outpatient · +11 other terms	116	$140	$416	$651	156%	—	$69 – $4.3k
4	Blue Cross Blue Shield fee schedule · outpatient · +7 other terms	92	$201	$207	$79	38%	—	$1 – $450
5	Humana fee schedule · outpatient · +5 other terms	63	$125	$126	$15	12%	—	$48 – $163
6	Molina facility · fee schedule · outpatient · +5 other terms	34	$118	$129	$50	39%	—	$65 – $319
7	Anthem facility · fee schedule · outpatient · +3 other terms	32	$118	$153	$91	60%	—	$48 – $349
8	WellCare fee schedule · outpatient · +4 other terms	32	$136	$137	$13	10%	—	$119 – $171
9	Bcbs Tx fee schedule · outpatient	30	$179	$184	$58	31%	—	$136 – $673
10	Devoted fee schedule · outpatient · +3 other terms	23	$125	$122	$5	4%	—	$116 – $139
11	Kaiser fee schedule · outpatient · +3 other terms	23	$125	$329	$268	81%	—	$125 – $1000
12	Optum fee schedule · outpatient · +2 other terms	22	$125	$151	$98	65%	—	$113 – $459
13	Ambetter fee schedule · outpatient · +2 other terms	20	$272	$267	$41	15%	—	$218 – $351
14	Medicare fee schedule · outpatient	18	$125	$125	—	—	—	$125 – $125
15	Caresource fee schedule · outpatient · +2 other terms	15	$51	$75	$54	72%	—	$48 – $199
16	Medical Mutual facility · fee schedule · outpatient · +1 other terms	13	$118	$123	$13	10%	—	$118 – $167
17	Wellmark fee schedule · both · +2 other terms	13	$500	$498	$13	3%	—	$420 – $500
18	Bcbs Nj fee schedule · outpatient	12	$415	$415	—	—	—	$415 – $415
19	Highmark fee schedule · outpatient · +4 other terms	12	$468	$510	$295	58%	—	$425 – $3.4k
20	Regence fee schedule · outpatient · +2 other terms	10	$146	$146	$4	3%	—	$140 – $156
21	Tricare fee schedule · outpatient · +1 other terms	10	$113	$115	$4	3%	—	$113 – $121
22	Medica fee schedule · both · +4 other terms	9	$551	$550	$5	1%	—	$546 – $556
23	Aetna Better Health facility · fee schedule · outpatient	5	$68	$68	$1	1%	—	$68 – $70
24	Clover fee schedule · outpatient	5	$120	$125	$9	7%	—	$120 – $140
25	Excellus facility · fee schedule · outpatient · +1 other terms	5	$751	$684	$458	67%	—	$103 – $2.0k

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