Wound dressing matrix, per square centimeter

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

Rebound matrix, per sq cm

Payers reporting HCPCS Q4296

Payer pricing summary

Low

$91

Average

$1.2k

Median

$660

High

$11.4k

Payer rate distribution

Filter by billing methodology

Filter by billing class

#
1	UnitedHealthcare fee schedule · outpatient · +9 other terms	418	$296	$1.6k	$2.2k	137%	—	$48 – $10.3k
2	Cigna fee schedule · outpatient · +7 other terms	263	$2.3k	$3.6k	$3.3k	91%	—	$119 – $12.4k
3	Aetna fee schedule · outpatient · +9 other terms	220	$146	$1.1k	$2.5k	225%	—	$69 – $23.4k
4	Humana fee schedule · outpatient · +7 other terms	180	$1.4k	$937	$1.4k	151%	—	$48 – $8.7k
5	Blue Cross Blue Shield fee schedule · outpatient · +6 other terms	175	$303	$7.8k	$7.4k	96%	—	$1 – $24.5k
6	Molina fee schedule · outpatient · +6 other terms	53	$192	$254	$403	159%	—	$51 – $3.4k
7	Anthem facility · fee schedule · outpatient · +5 other terms	52	$177	$752	$929	124%	—	$48 – $3.9k
8	Caresource fee schedule · outpatient · +3 other terms	49	$191	$541	$725	134%	—	$48 – $2.5k
9	WellCare fee schedule · outpatient · +5 other terms	48	$140	$336	$558	166%	—	$115 – $2.4k
10	Kaiser fee schedule · outpatient · +4 other terms	41	$207	$347	$620	179%	—	$125 – $4.8k
11	Ambetter fee schedule · outpatient · +3 other terms	38	$248	$569	$863	152%	—	$162 – $3.0k
12	Devoted fee schedule · outpatient · +3 other terms	34	$125	$125	$8	6%	—	$116 – $139
13	Optum fee schedule · outpatient · +2 other terms	32	$125	$173	$91	53%	—	$113 – $459
14	Bcbs Tx fee schedule · outpatient	30	$11.0k	$11.4k	$3.6k	31%	—	$8.4k – $41.6k
15	Healthpartners fee schedule · outpatient · +1 other terms	19	$2.7k	$2.7k	$424	16%	—	$131 – $2.8k
16	Oscar facility · fee schedule · outpatient · +2 other terms	19	$234	$672	$735	109%	—	$175 – $1.8k
17	Medicare fee schedule · outpatient · +1 other terms	18	$125	$125	—	—	—	$125 – $125
18	Medical Mutual facility · fee schedule · outpatient · +2 other terms	17	$142	$2.3k	$2.1k	91%	—	$64 – $6.2k
19	Highmark fee schedule · outpatient · +4 other terms	16	$1.8k	$1.8k	$460	26%	—	$127 – $3.4k
20	Wellmark fee schedule · both · +1 other terms	14	$2.3k	$2.2k	$126	6%	—	$1.5k – $2.3k
21	Bcbs Nj fee schedule · outpatient	11	$2.0k	$1.9k	$564	29%	—	$870 – $2.2k
22	Tricare fee schedule · outpatient · +1 other terms	11	$113	$118	$10	8%	—	$113 – $148
23	Regence fee schedule · outpatient · +3 other terms	10	$146	$146	$4	3%	—	$140 – $156
24	Clover fee schedule · outpatient · +2 other terms	9	$140	$576	$637	111%	—	$120 – $1.5k
25	Medica fee schedule · both · +3 other terms	9	$2.5k	$2.5k	$22	1%	—	$2.5k – $2.5k

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