Sterile gauze pad, 16 sq. in. or smaller, no 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 (Sup Shell A6402) Sterile Gauze <= 16 Sq In - A6402 - RU272059

Payers reporting HCPCS A6402

Payer pricing summary

Low

Average

Median

High

$37

Payer rate distribution

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#
1	UnitedHealthcare fee schedule · outpatient · +19 other terms	303	$0	$3	$18	608%	—	$0 – $122
2	Humana fee schedule · outpatient · +17 other terms	302	$0	$0	$0	113%	—	$0 – $1
3	Aetna fee schedule · outpatient · +18 other terms	266	$0	$0	$0	59%	—	$0 – $1
4	WellCare fee schedule · outpatient · +5 other terms	185	$0	$0	$0	44%	—	$0 – $1
5	Blue Cross Blue Shield fee schedule · outpatient · +15 other terms	182	$0	$0	$0	133%	—	$0 – $2
6	Devoted fee schedule · outpatient · +6 other terms	162	$0	$0	—	—	—	$0 – $0
7	Cigna Healthspring fee schedule · outpatient · +3 other terms	116	$0	$0	—	—	—	$0 – $0
8	Molina fee schedule · outpatient · +11 other terms	96	$0	$0	$0	40%	—	$0 – $0
9	Cigna fee schedule · outpatient · +15 other terms	77	$0	$0	$1	320%	—	$0 – $7
10	Anthem fee schedule · outpatient · +11 other terms	74	$0	$0	$0	104%	—	$0 – $1
11	Superior Healthplan fee schedule · outpatient · +2 other terms	41	$0	$0	$1	228%	—	$0 – $5
12	Kaiser fee schedule · outpatient · +6 other terms	39	$0	$0	—	—	—	$0 – $0
13	Clover fee schedule · outpatient · +1 other terms	37	$0	$0	—	—	—	$0 – $0
14	Bcbs Tx fee schedule · outpatient · +3 other terms	31	$0	$0	$0	27%	—	$0 – $1
15	Caresource fee schedule · outpatient · +7 other terms	30	$0	$70	$60	86%	—	$0 – $122
16	Optum fee schedule · outpatient · +5 other terms	25	$0	$0	$0	39%	—	$0 – $0
17	Oscar fee schedule · outpatient · +2 other terms	24	$0	$0	—	—	—	$0 – $0
18	Medicare fee schedule · outpatient · +2 other terms	18	$0	$0	—	—	—	$0 – $0
19	Highmark facility · fee schedule · outpatient · +6 other terms	17	$0	$0	$0	69%	—	$0 – $2
20	Ambetter facility · fee schedule · outpatient · +8 other terms	16	$0	$0	$0	22%	—	$0 – $0
21	Amerihealth Caritas fee schedule · outpatient · +4 other terms	16	$0	$0	—	—	—	$0 – $0
22	Aetna Better Health fee schedule · outpatient · +9 other terms	13	$0	$0	$0	33%	—	$0 – $0
23	Wellmark fee schedule · both · +1 other terms	13	$0	$0	$0	40%	—	$0 – $1
24	Bcbs Mn fee schedule · outpatient · +4 other terms	12	$0	$0	$0	111%	—	$0 – $1
25	Bcbs Nj fee schedule · outpatient	12	$0	$0	$0	69%	—	$0 – $1

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