Sterile transparent wound dressing film, 16 to 48 square inches

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

DRESSING FLEXGRID 4X4-3\4

Payers reporting HCPCS A6258

Payer pricing summary

Low

Average

$12

Median

High

$219

Payer rate distribution

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#
1	Humana fee schedule · outpatient · +15 other terms	311	$6	$9	$10	104%	—	$2 – $47
2	UnitedHealthcare fee schedule · outpatient · +18 other terms	303	$6	$6	$2	25%	—	$1 – $17
3	Aetna fee schedule · outpatient · +16 other terms	275	$6	$7	$3	47%	—	$1 – $37
4	Blue Cross Blue Shield fee schedule · outpatient · +14 other terms	205	$6	$8	$3	46%	—	$0 – $26
5	WellCare fee schedule · outpatient · +7 other terms	186	$6	$7	$1	17%	—	$2 – $12
6	Devoted fee schedule · outpatient · +6 other terms	162	$6	$6	$0	2%	—	$6 – $7
7	Cigna Healthspring fee schedule · outpatient · +1 other terms	116	$6	$6	$0	3%	—	$6 – $7
8	Molina fee schedule · outpatient · +11 other terms	96	$8	$8	$3	39%	—	$5 – $16
9	Cigna fee schedule · outpatient · +15 other terms	87	$6	$12	$11	90%	—	$5 – $37
10	Anthem fee schedule · outpatient · +12 other terms	74	$6	$6	$1	8%	—	$6 – $10
11	Superior Healthplan fee schedule · outpatient · +1 other terms	41	$6	$7	$7	94%	—	$1 – $84
12	Kaiser fee schedule · outpatient · +7 other terms	39	$6	$6	$0	2%	—	$6 – $6
13	Clover fee schedule · outpatient · +1 other terms	37	$6	$6	$0	3%	—	$6 – $6
14	Bcbs Tx fee schedule · outpatient · +3 other terms	31	$6	$6	$2	29%	—	$4 – $21
15	Optum fee schedule · outpatient · +4 other terms	31	$6	$11	$8	70%	—	$6 – $31
16	Oscar fee schedule · outpatient · +2 other terms	24	$6	$6	$0	3%	—	$6 – $6
17	Caresource facility · case rate · outpatient · +6 other terms	20	$15	$15	$5	32%	—	$6 – $27
18	Medicare fee schedule · outpatient · +4 other terms	18	$6	$6	$0	1%	—	$6 – $6
19	Amerihealth Caritas fee schedule · outpatient · +4 other terms	16	$7	$7	$0	2%	—	$7 – $7
20	Aetna Better Health fee schedule · outpatient · +6 other terms	13	$3	$5	$2	32%	—	$3 – $6
21	MultiPlan fee schedule · outpatient · +12 other terms	13	$10	$18	$9	53%	—	$6 – $28
22	Wellmark fee schedule · both · +2 other terms	13	$5	$5	$0	3%	—	$4 – $5
23	Ambetter case rate · outpatient · +8 other terms	12	$9	$9	$0	4%	—	$9 – $10
24	Bcbs Mn fee schedule · outpatient · +5 other terms	12	$5	$4	$3	73%	—	$0 – $7
25	Bcbs Nj fee schedule · outpatient	12	$4	$9	$9	105%	—	$1 – $27

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