Large sterile wound dressing pad 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

DRSNG SILVERLON ISLAND 4X14"

Payers reporting HCPCS A6255

Payer pricing summary

Low

Average

$32

Median

High

$538

Payer rate distribution

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#
1	UnitedHealthcare fee schedule · outpatient · +14 other terms	311	$4	$11	$26	246%	—	$2 – $122
2	Humana fee schedule · outpatient · +12 other terms	306	$4	$8	$12	163%	—	$2 – $118
3	Aetna fee schedule · outpatient · +14 other terms	270	$4	$5	$2	48%	—	$2 – $26
4	Blue Cross Blue Shield fee schedule · outpatient · +11 other terms	192	$4	$5	$2	43%	—	$0 – $18
5	WellCare fee schedule · outpatient · +7 other terms	185	$4	$5	$1	16%	—	$4 – $8
6	Devoted fee schedule · outpatient · +3 other terms	163	$4	$4	$0	2%	—	$4 – $5
7	Cigna Healthspring fee schedule · outpatient · +1 other terms	116	$4	$4	$0	3%	—	$4 – $5
8	Molina fee schedule · outpatient · +6 other terms	97	$6	$6	$2	39%	—	$4 – $11
9	Cigna fee schedule · outpatient · +13 other terms	83	$4	$29	$44	152%	—	$4 – $127
10	Anthem fee schedule · outpatient · +11 other terms	74	$4	$4	$0	8%	—	$4 – $7
11	Superior Healthplan fee schedule · outpatient	40	$5	$5	$0	0%	—	$4 – $5
12	Kaiser fee schedule · outpatient · +6 other terms	39	$4	$4	$0	2%	—	$4 – $4
13	Clover fee schedule · outpatient · +1 other terms	37	$4	$4	$0	3%	—	$4 – $5
14	Bcbs Tx fee schedule · outpatient	31	$4	$4	$1	29%	—	$3 – $15
15	Optum fee schedule · outpatient · +2 other terms	31	$4	$37	$47	130%	—	$4 – $150
16	Caresource fee schedule · outpatient · +5 other terms	30	$4	$90	$52	58%	—	$4 – $122
17	Oscar fee schedule · outpatient · +2 other terms	24	$4	$4	$0	3%	—	$4 – $5
18	Medicare fee schedule · outpatient	18	$4	$4	$0	1%	—	$4 – $4
19	Amerihealth Caritas fee schedule · outpatient · +1 other terms	16	$5	$5	$0	2%	—	$5 – $5
20	Aetna Better Health fee schedule · outpatient · +3 other terms	13	$2	$3	$1	36%	—	$2 – $4
21	Wellmark fee schedule · both · +1 other terms	13	$4	$4	$0	3%	—	$3 – $4
22	Ambetter case rate · outpatient · +5 other terms	12	$6	$6	$0	4%	—	$6 – $7
23	Bcbs Mn fee schedule · outpatient · +4 other terms	12	$4	$3	$2	68%	—	$0 – $5
24	Bcbs Nj fee schedule · outpatient	12	$4	$9	$6	68%	—	$4 – $19
25	Highmark fee schedule · outpatient · +6 other terms	10	$4	$5	$2	36%	—	$2 – $10

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