Integra or Omnigraft dermal regeneration template at AMH Cath Labs LLC

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

MATRIX BLYR WND 10X25/250 SQCM

Arlington, TX

See all hospitals reporting HCPCS Q4105 →

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Pricing by billing methodology

Price type

How this price compares nationally

AMH Cath Labs LLC’s median price of $125 is 1% below the median hospital's median price ($127), higher than 48% of the 1,343 hospitals reporting HCPCS Q4105. The highlighted bar is where this hospital falls; shaded is the middle 50% of hospitals.

Payers reporting HCPCS Q4105 at AMH Cath Labs LLC

Negotiated rates from the hospital’s own file: 9 payers, 33 plan rates. A facility fee, a professional fee, a per diem and a case rate are different bills, so each is listed on its own. Open a payer to see it across hospitals.

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1	Blue Cross Blue Shield managed medicaid percent of total billed charges · outpatientfrom % of charges	$17	$17	$4	23%	—	$13 – $21
2	UnitedHealthcare managed medicaid percent of total billed charges · outpatientfrom % of charges	$17	$17	$4	23%	—	$13 – $21
3	WellCare managed medicaid percent of total billed charges · outpatientfrom % of charges	$18	$18	$4	23%	—	$14 – $22
4	Molina managed medicaid percent of total billed charges · outpatientfrom % of charges	$19	$19	$4	23%	—	$14 – $23
5	Aetna managed medicaid percent of total billed charges · outpatientfrom % of charges	$19	$19	$4	23%	—	$15 – $23
6	Aetna whole health percent of total billed charges · inpatientfrom % of charges	$67	$67	$15	23%	—	$51 – $82
7	Aetna whole health percent of total billed charges · outpatientfrom % of charges	$79	$79	$18	23%	—	$61 – $98
8	Aetna commercial percent of total billed charges · inpatientfrom % of charges	$89	$89	$21	23%	—	$69 – $110
9	Blue Cross Blue Shield hmo fee schedule · outpatient	$95	$95	—	—	—	$95 – $95
10	Blue Cross Blue Shield exchange fee schedule · outpatient	$98	$98	—	—	—	$98 – $98
11	UnitedHealthcare all payer percent of total billed charges · outpatientfrom % of charges	$100	$100	$23	23%	—	$77 – $123
12	Blue Cross Blue Shield ppo fee schedule · outpatient	$106	$106	—	—	—	$106 – $106
13	Aetna commercial percent of total billed charges · outpatientfrom % of charges	$106	$106	$24	23%	—	$82 – $130
14	UnitedHealthcare ppo percent of total billed charges · outpatientfrom % of charges	$106	$106	$24	23%	—	$82 – $130
15	Cigna oap/hmo percent of total billed charges · outpatientfrom % of charges	$107	$107	$25	23%	—	$82 – $131
16	Blue Cross Blue Shield medicare advantage case rate · outpatient	$125	$125	—	—	—	$125 – $125
17	Humana medicare advantage case rate · outpatient	$130	$130	—	—	—	$130 – $130
18	Humana medicare advantage ppo case rate · outpatient	$130	$130	—	—	—	$130 – $130
19	Molina medicare advantage case rate · outpatient	$131	$131	—	—	—	$131 – $131
20	WellCare medicare advantage hmo case rate · outpatient	$131	$131	—	—	—	$131 – $131
21	Phcs ppo percent of total billed charges · outpatientfrom % of charges	$134	$134	$31	23%	—	$103 – $165
22	Cigna ppo percent of total billed charges · outpatientfrom % of charges	$135	$135	$31	23%	—	$104 – $166
23	Aetna asa percent of total billed charges · outpatientfrom % of charges	$136	$136	$31	23%	—	$104 – $167
24	Aetna coventry percent of total billed charges · outpatientfrom % of charges	$136	$136	$31	23%	—	$104 – $167
25	WellCare medicare advantage mmp case rate · outpatient	$138	$138	—	—	—	$138 – $138

Page 1 of 2 · 33 rates

Last updated: Apr 21, 2026

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