Silicone gel sheet

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

HB-Cica Care Sheet, per Each

Payers reporting HCPCS A6025

Payer pricing summary

Low

Average

$251

Median

$110

High

$5.5k

Payer rate distribution

Filter by billing methodology

Filter by billing class

#
1	Humana fee schedule · outpatient · +10 other terms	77	$55	$75	$58	77%	—	$1 – $161
2	Aetna fee schedule · outpatient · +15 other terms	32	$17	$31	$24	78%	—	$8 – $117
3	Medical Mutual facility · percent of total billed charges · bothfrom % of charges · +3 other terms	29	$95	$88	$22	25%	—	$37 – $138
4	Blue Cross Blue Shield fee schedule · outpatient · +15 other terms	28	$46	$52	$61	118%	—	$0 – $341
5	UnitedHealthcare fee schedule · both · +17 other terms	26	$10	$19	$11	62%	—	$10 – $46
6	Anthem facility · case rate · outpatient · +12 other terms	15	$15	$17	$4	23%	—	$10 – $26
7	Caresource facility · case rate · outpatient · +7 other terms	15	$16	$17	$4	23%	—	$10 – $27
8	Cigna fee schedule · both · +15 other terms	15	$38	$35	$7	21%	—	$15 – $38
9	Molina facility · case rate · outpatient · +11 other terms	15	$15	$17	$4	23%	—	$11 – $26
10	Wellmark fee schedule · both · +6 other terms	13	$20	$22	$11	52%	—	$20 – $90
11	Bcbs Mn fee schedule · outpatient · +5 other terms	12	$21	$13	$12	89%	—	$0 – $26
12	Bcbs Nj fee schedule · outpatient	12	$35	$35	—	—	—	$35 – $35
13	Highmark fee schedule · outpatient · +6 other terms	12	$33	$33	$2	5%	—	$33 – $46
14	Medica fee schedule · outpatient · +10 other terms	11	$34	$34	$9	27%	—	$20 – $62
15	Optum facility · case rate · outpatient · +6 other terms	11	$14	$16	$4	22%	—	$13 – $24
16	Sanford Health Plan facility · percent of total billed charges · inpatientfrom % of charges · +3 other terms	11	$36	$137	$153	111%	—	$36 – $522
17	Ucare facility · percent of total billed charges · outpatientfrom % of charges · +3 other terms	10	$26	$25	$1	4%	—	$23 – $26
18	Magellan facility · percent of total billed charges · bothfrom % of charges · +2 other terms	9	$82	$89	$53	60%	—	$32 – $201
19	Aetna Better Health fee schedule · inpatient · +2 other terms	7	$8	$8	—	—	—	$8 – $8
20	Cigna Healthspring percent of total billed charges · outpatientfrom % of charges	7	$163	$164	$83	51%	—	$41 – $333
21	Tricare percent of total billed charges · outpatientfrom % of charges · +1 other terms	7	$163	$164	$83	51%	—	$41 – $333
22	Bcbs Id fee schedule · outpatient · +2 other terms	4	$34	$34	—	—	—	$34 – $34
23	Healthpartners facility · other · outpatient · +3 other terms	4	$86	$86	—	—	—	$86 – $86
24	Amerihealth Caritas professional · fee schedule · outpatient · +4 other terms	3	$63	$63	$1	2%	—	$62 – $64
25	Bcbs Ks fee schedule · outpatient · +1 other terms	3	$84	$87	$5	6%	—	$83 – $95

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