Large sterile foam wound dressing with 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

HC FOAM DRSNG >48 SQ" W/ BRDR

Payers reporting HCPCS A6214

Payer pricing summary

Low

Average

$24

Median

$19

High

$99

Payer rate distribution

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#
1	Aetna Better Health fee schedule · outpatient · +5 other terms	13	$7	$10	$3	33%	3–30	$7 – $14
2	Humana fee schedule · outpatient · +15 other terms	301	$15	$22	$23	105%	—	$4 – $113
3	UnitedHealthcare fee schedule · outpatient · +18 other terms	293	$15	$14	$4	27%	—	$6 – $76
4	Aetna fee schedule · outpatient · +17 other terms	268	$15	$16	$8	51%	—	$6 – $89
5	Blue Cross Blue Shield fee schedule · outpatient · +14 other terms	189	$15	$18	$8	46%	—	$0 – $61
6	WellCare fee schedule · outpatient · +7 other terms	185	$15	$16	$3	16%	—	$14 – $29
7	Devoted fee schedule · outpatient · +4 other terms	163	$15	$15	$0	2%	—	$14 – $16
8	Cigna Healthspring fee schedule · outpatient · +2 other terms	116	$15	$15	$0	3%	—	$15 – $16
9	Molina fee schedule · outpatient · +9 other terms	96	$20	$20	$8	39%	—	$12 – $38
10	Cigna fee schedule · outpatient · +14 other terms	80	$15	$17	$7	41%	—	$14 – $74
11	Anthem fee schedule · outpatient · +13 other terms	74	$14	$15	$1	8%	—	$14 – $24
12	Superior Healthplan fee schedule · outpatient · +1 other terms	40	$15	$15	$0	0%	—	$14 – $15
13	Kaiser fee schedule · outpatient · +8 other terms	39	$14	$15	$0	2%	—	$14 – $15
14	Clover fee schedule · outpatient · +1 other terms	37	$15	$15	$0	3%	—	$14 – $15
15	Bcbs Tx fee schedule · outpatient	31	$14	$14	$4	29%	—	$10 – $50
16	Optum fee schedule · outpatient · +5 other terms	25	$15	$17	$7	42%	—	$14 – $37
17	Oscar fee schedule · outpatient · +5 other terms	24	$14	$15	$1	3%	—	$14 – $15
18	Caresource facility · case rate · outpatient · +7 other terms	20	$16	$19	$6	30%	—	$10 – $29
19	Ambetter facility · fee schedule · outpatient · +10 other terms	19	$26	$24	$3	11%	—	$21 – $26
20	Medicare fee schedule · outpatient · +2 other terms	18	$14	$14	$0	1%	—	$14 – $14
21	Amerihealth Caritas fee schedule · outpatient · +6 other terms	16	$18	$17	$0	2%	—	$17 – $18
22	Wellmark fee schedule · both · +2 other terms	13	$13	$13	$0	3%	—	$11 – $13
23	Bcbs Mn fee schedule · outpatient · +4 other terms	12	$13	$8	$7	81%	—	$0 – $16
24	Bcbs Nj fee schedule · outpatient	12	$14	$31	$21	68%	—	$14 – $64
25	Highmark fee schedule · outpatient · +4 other terms	11	$15	$16	$6	36%	—	$7 – $35

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