Large sterile foam wound dressing without adhesive border

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-Mepilex Ag Dressing, No Border 8x20 per Sht

Payers reporting HCPCS A6211

Payer pricing summary

Low

Average

$78

Median

$54

High

$508

Payer rate distribution

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#
1	UnitedHealthcare fee schedule · outpatient · +19 other terms	315	$42	$44	$23	53%	—	$1 – $179
2	Humana fee schedule · outpatient · +19 other terms	306	$42	$63	$67	106%	—	$1 – $322
3	Aetna fee schedule · outpatient · +18 other terms	273	$42	$48	$32	68%	—	$1 – $280
4	Blue Cross Blue Shield fee schedule · outpatient · +17 other terms	202	$43	$51	$25	49%	—	$0 – $305
5	WellCare fee schedule · outpatient · +8 other terms	187	$43	$44	$7	16%	—	$41 – $82
6	Devoted fee schedule · outpatient · +5 other terms	163	$42	$42	$1	2%	—	$40 – $44
7	Cigna Healthspring fee schedule · outpatient · +3 other terms	116	$43	$43	$1	3%	—	$42 – $45
8	Molina fee schedule · outpatient · +13 other terms	97	$59	$58	$32	56%	—	$1 – $386
9	Cigna fee schedule · outpatient · +14 other terms	80	$43	$48	$19	38%	—	$38 – $154
10	Anthem fee schedule · outpatient · +14 other terms	79	$41	$23	$15	65%	—	$2 – $68
11	Kaiser fee schedule · outpatient · +9 other terms	40	$41	$44	$17	39%	—	$40 – $154
12	Superior Healthplan fee schedule · outpatient · +1 other terms	40	$44	$44	$0	0%	—	$41 – $44
13	Clover fee schedule · outpatient · +1 other terms	37	$42	$42	$1	3%	—	$41 – $44
14	Caresource fee schedule · outpatient · +8 other terms	34	$42	$92	$42	45%	—	$1 – $122
15	Bcbs Tx fee schedule · outpatient	31	$39	$39	$12	29%	—	$29 – $143
16	Optum fee schedule · outpatient · +7 other terms	25	$42	$49	$20	42%	—	$40 – $105
17	Oscar fee schedule · outpatient · +5 other terms	24	$41	$42	$1	3%	—	$41 – $44
18	Ambetter facility · fee schedule · outpatient · +9 other terms	19	$75	$68	$7	11%	—	$61 – $75
19	Medicare fee schedule · outpatient · +4 other terms	18	$40	$40	$0	1%	—	$40 – $41
20	Amerihealth Caritas fee schedule · outpatient · +5 other terms	16	$50	$50	$1	2%	—	$48 – $50
21	Medica fee schedule · outpatient · +11 other terms	14	$72	$66	$31	47%	—	$10 – $105
22	Aetna Better Health fee schedule · outpatient · +5 other terms	13	$20	$28	$10	35%	—	$20 – $41
23	Medcost percent of total billed charges · bothfrom % of charges · +3 other terms	13	$258	$258	$15	6%	—	$243 – $273
24	Wellmark fee schedule · both · +4 other terms	13	$37	$37	$1	3%	—	$30 – $37
25	Bcbs Mn fee schedule · outpatient · +6 other terms	12	$36	$23	$20	85%	—	$0 – $45

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