Xwrap fenestrated skin graft wrap, 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 fenestra, per square centimeter (add-on, list separately in addition to primary procedure)

Anthem pricing summary

Low

$118

Average

$205

Median

$155

High

$517

Anthem rate distribution

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48 hospital rates

#		Plans
1	AKRON GENERAL MEDICAL CENTER Akron, OH facility · fee schedule · outpatient	3	$296	$254	$99	39%	—	$118 – $349
2	Aspirus Divine Savior Hospital Portage, WI fee schedule · outpatient	2	$515	$515	$392	76%	—	$123 – $907
3	Aspirus Rhinelander Hospital Rhinelander, WI fee schedule · outpatient	2	$515	$515	$392	76%	—	$123 – $907
4	Aspirus St. Luke’s Hospital Duluth, MN fee schedule · outpatient	2	$193	$193	$64	33%	—	$129 – $258
5	Aspirus Stevens Point Hospital Stevens Point, WI fee schedule · outpatient	2	$515	$515	$392	76%	—	$123 – $907
6	Aspirus Wausau Hospital Wausau, WI fee schedule · outpatient	2	$517	$517	$393	76%	—	$124 – $911
7	Aspirus Wisconsin Rapids Hospital Wisconsin Rapids, WI fee schedule · outpatient	2	$515	$515	$392	76%	—	$123 – $907
8	Boulder Community Health Lafayette, CO facility · case rate · outpatient	3	$297	$332	$117	35%	—	$133 – $501
9	Boulder Community Health Lafayette, CO professional · fee schedule · both	3	$165	$181	$31	17%	—	$135 – $223
10	CATHOLIC HEALTH INIATIVES COLORADO Westminster, CO fee schedule · outpatient	1	$125	$125	—	—	—	$125 – $125
11	CATHOLIC HEALTH INITIATIVES COLORADO Pueblo, CO fee schedule · outpatient	1	$125	$125	—	—	—	$125 – $125
12	CATHOLIC HEALTH INITIATIVES COLORADO Colorado Springs, CO fee schedule · outpatient	1	$125	$125	—	—	—	$125 – $125
13	CATHOLIC HEALTH INITIATIVES COLORADO Frisco, CO fee schedule · outpatient	1	$125	$125	—	—	—	$125 – $125
14	CATHOLIC HEALTH INITIATIVES COLORADO Durango, CO fee schedule · outpatient	1	$125	$125	—	—	—	$125 – $125
15	CATHOLIC HEALTH INITIATIVES COLORADO Lakewood, CO fee schedule · outpatient	1	$125	$125	—	—	—	$125 – $125
16	CATHOLIC HEALTH INITIATIVES COLORADO Colorado Springs, CO fee schedule · outpatient	1	$125	$125	—	—	—	$125 – $125
17	CATHOLIC HEALTH INITIATIVES COLORADO Fort Morgan, CO fee schedule · outpatient	1	$125	$125	—	—	—	$125 – $125
18	CLEVELAND CLINIC AVON HOSPITAL Avon, OH facility · fee schedule · outpatient	2	$186	$186	$69	37%	—	$118 – $255
19	CLEVELAND CLINIC HEALTH SYSTEM - EAST REGION Mentor, OH facility · fee schedule · outpatient	3	$289	$249	$95	38%	—	$118 – $340
20	CLEVELAND CLINIC HEALTH SYSTEM - EAST REGION Euclid, OH facility · fee schedule · outpatient	2	$186	$186	$69	37%	—	$118 – $255
21	CLEVELAND CLINIC HEALTH SYSTEM - EAST REGION Warrensville Heights, OH facility · fee schedule · outpatient	2	$186	$186	$69	37%	—	$118 – $255
22	Cleveland Clinic Mercy Hospital Canton, OH facility · fee schedule · outpatient	1	$118	$118	—	—	—	$118 – $118
23	Fairview Hospital Cleveland, OH facility · fee schedule · outpatient	3	$289	$249	$95	38%	—	$118 – $340
24	Gundersen Luthern Medical Center Inc La Crosse, WI facility · fee schedule · outpatient	1	$132	$132	—	—	—	$132 – $132
25	Howard Young Medical Center Woodruff, WI fee schedule · outpatient	2	$515	$515	$392	76%	—	$123 – $907

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HCPCS Q4406