Integra dermal matrix skin substitute

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 WOUND 2X2IN COLLASORB 90% COLLAGEN 10% CALCIUM ALGINATE EXTRACELLULAR MATRIX HEALING STERILE

Payers reporting HCPCS Q4108

Payer pricing summary

Low

$63

Average

$1.4k

Median

$676

High

$10.1k

Payer rate distribution

Filter by billing methodology

Filter by billing class

#
1	UnitedHealthcare fee schedule · outpatient · +22 other terms	475	$147	$320	$1.2k	388%	—	$1 – $23.0k
2	Cigna fee schedule · outpatient · +20 other terms	341	$108	$407	$1.7k	426%	—	$38 – $19.5k
3	Aetna fee schedule · outpatient · +22 other terms	278	$127	$1.1k	$2.4k	209%	—	$44 – $16.0k
4	Blue Cross Blue Shield fee schedule · outpatient · +23 other terms	253	$121	$184	$445	242%	—	$1 – $10.2k
5	Humana fee schedule · outpatient · +22 other terms	240	$121	$345	$1.2k	352%	—	$1 – $8.6k
6	Molina fee schedule · outpatient · +17 other terms	91	$149	$902	$3.0k	332%	—	$1 – $22.0k
7	Caresource fee schedule · outpatient · +13 other terms	64	$91	$232	$255	110%	—	$1 – $2.8k
8	Anthem facility · fee schedule · outpatient · +17 other terms	60	$140	$187	$198	106%	—	$43 – $1.2k
9	Ambetter facility · fee schedule · outpatient · +11 other terms	57	$212	$227	$50	22%	—	$45 – $331
10	Kaiser fee schedule · outpatient · +18 other terms	56	$261	$3.8k	$5.5k	144%	—	$19 – $23.6k
11	WellCare fee schedule · outpatient · +15 other terms	49	$135	$129	$27	21%	—	$50 – $171
12	Devoted facility · fee schedule · outpatient · +9 other terms	35	$118	$125	$10	8%	—	$112 – $162
13	Optum fee schedule · outpatient · +11 other terms	33	$125	$909	$1.8k	203%	—	$113 – $8.1k
14	Bcbs Tx fee schedule · outpatient · +1 other terms	30	$169	$153	$51	33%	—	$63 – $265
15	Highmark facility · fee schedule · outpatient · +12 other terms	30	$96	$88	$66	75%	—	$39 – $401
16	Oscar facility · fee schedule · outpatient · +8 other terms	26	$118	$132	$74	56%	—	$41 – $234
17	Amerihealth Caritas other · outpatient · +7 other terms	25	$1.3k	$1.4k	$1.1k	78%	—	$1 – $5.9k
18	Baylor Scott White Health Plan facility · fee schedule · outpatient · +2 other terms	25	$158	$158	$31	20%	—	$119 – $207
19	Bcbs La fee schedule · outpatient · +2 other terms	25	$52	$51	$3	6%	—	$42 – $56
20	MultiPlan fee schedule · inpatient · +14 other terms	24	$11.3k	$13.1k	$6.4k	49%	—	$293 – $29.5k
21	Tricare facility · fee schedule · outpatient · +8 other terms	23	$127	$218	$586	268%	—	$109 – $4.2k
22	Clover facility · fee schedule · outpatient · +6 other terms	21	$134	$129	$9	7%	—	$113 – $139
23	First Health fee schedule · outpatient · +13 other terms	21	$9.5k	$11.1k	$6.0k	54%	—	$253 – $26.8k
24	Regence professional · fee schedule · outpatient · +9 other terms	21	$47	$52	$22	43%	—	$47 – $153
25	Superior Healthplan facility · fee schedule · outpatient · +4 other terms	21	$131	$129	$3	2%	—	$125 – $131

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