Skin substitute wound dressing, 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

Xwrap 2.0, per square centimeter (add-on, list separately in addition to primary procedure)

Payers reporting HCPCS Q4402

Payer pricing summary

Low

Average

$152

Median

$140

High

$278

Payer rate distribution

Filter by billing methodology

Filter by billing class

#
1	UnitedHealthcare fee schedule · outpatient · +6 other terms	218	$210	$232	$66	29%	—	$108 – $483
2	Aetna facility · fee schedule · outpatient · +6 other terms	58	$128	$146	$102	70%	—	$69 – $980
3	Humana fee schedule · outpatient · +4 other terms	40	$127	$135	$14	10%	—	$125 – $171
4	Blue Cross Blue Shield fee schedule · outpatient · +4 other terms	34	$163	$195	$58	30%	—	$69 – $314
5	Molina facility · fee schedule · outpatient · +5 other terms	33	$118	$129	$51	39%	—	$65 – $319
6	Cigna fee schedule · outpatient · +3 other terms	28	$275	$280	$176	63%	—	$125 – $644
7	WellCare fee schedule · outpatient · +4 other terms	28	$141	$142	$10	7%	—	$127 – $158
8	Devoted facility · fee schedule · outpatient · +3 other terms	23	$118	$124	$11	9%	—	$118 – $143
9	Anthem fee schedule · outpatient · +3 other terms	22	$140	$295	$314	106%	—	$123 – $911
10	Kaiser fee schedule · outpatient · +2 other terms	22	$125	$307	$247	80%	—	$125 – $1000
11	Ambetter fee schedule · outpatient · +2 other terms	18	$256	$263	$41	16%	—	$218 – $351
12	Medicare fee schedule · outpatient	18	$125	$125	—	—	—	$125 – $125
13	Caresource facility · fee schedule · outpatient · +2 other terms	14	$212	$180	$42	23%	—	$121 – $238
14	Medical Mutual facility · fee schedule · outpatient · +1 other terms	13	$118	$123	$13	10%	—	$118 – $167
15	Optum fee schedule · outpatient	12	$125	$180	$125	69%	—	$125 – $459
16	Regence fee schedule · outpatient · +2 other terms	9	$146	$145	$3	2%	—	$140 – $150
17	Excellus fee schedule · outpatient · +2 other terms	6	$236	$230	$60	26%	—	$127 – $351
18	Aetna Better Health facility · fee schedule · outpatient	5	$68	$68	$1	1%	—	$68 – $70
19	Highmark fee schedule · outpatient · +2 other terms	5	$155	$179	$57	32%	—	$127 – $279
20	Tricare facility · fee schedule · outpatient	4	$121	$118	$5	4%	—	$109 – $121
21	First Health professional · fee schedule · both	3	$122	$122	—	—	—	$122 – $122
22	Oscar facility · fee schedule · outpatient · +1 other terms	3	$182	$182	—	—	—	$182 – $182
23	Bcbs Al facility · case rate · outpatient	2	$125	$125	—	—	—	$125 – $125
24	Bcbs Id fee schedule · outpatient	2	$140	$140	—	—	—	$140 – $140
25	Bcbs Ks fee schedule · outpatient	2	$125	$125	—	—	—	$125 – $125

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