Integra bone matrix wound dressing at Aurora Medical Center Summit

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

1164416 - MATRIX WND 5 CM X 5 CM 25 CM2 BILAYER WND MTRX BOVINE CLGN

Summit, WI

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Pricing by billing methodology

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How this price compares nationally

Aurora Medical Center Summit’s median price of $86 is 37% below the median hospital's median price ($136), higher than 22% of the 1,716 hospitals reporting HCPCS Q4104. The highlighted bar is where this hospital falls; shaded is the middle 50% of hospitals.

Payers reporting HCPCS Q4104 at Aurora Medical Center Summit

Negotiated rates from the hospital’s own file: 6 payers, 21 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	Aetna hmo fee schedule · outpatient	$54	$54	—	—	—	$54 – $54
2	Healthpartners employee trust fund fee schedule · outpatient	$61	$61	—	—	—	$61 – $61
3	Healthpartners robin fee schedule · outpatient	$64	$64	—	—	—	$64 – $64
4	Cigna ppo-gppo fee schedule · outpatient	$79	$79	—	—	—	$79 – $79
5	Molina commercial fee schedule · outpatient	$128	$128	—	—	—	$128 – $128
6	UnitedHealthcare charter percent of total billed charges · outpatientfrom % of charges	$237	$237	$169	71%	—	$68 – $406
7	UnitedHealthcare exchange percent of total billed charges · outpatientfrom % of charges	$237	$237	$169	71%	—	$68 – $406
8	UnitedHealthcare hmo percent of total billed charges · outpatientfrom % of charges	$237	$237	$169	71%	—	$68 – $406
9	UnitedHealthcare nexus percent of total billed charges · outpatientfrom % of charges	$237	$237	$169	71%	—	$68 – $406
10	Anthem blue priority percent of total billed charges · outpatientfrom % of charges	$240	$240	$171	71%	—	$69 – $410
11	Anthem blue preferred percent of total billed charges · outpatientfrom % of charges	$260	$260	$185	71%	—	$75 – $444
12	Healthpartners broad percent of total billed charges · inpatientfrom % of charges	$299	$299	$213	71%	—	$86 – $513
13	Healthpartners broad percent of total billed charges · outpatientfrom % of charges	$299	$299	$213	71%	—	$86 – $513
14	Aetna ppo percent of total billed charges · inpatientfrom % of charges	$330	$330	$235	71%	—	$95 – $565
15	Aetna ppo percent of total billed charges · outpatientfrom % of charges	$330	$330	$235	71%	—	$95 – $565
16	UnitedHealthcare ppo percent of total billed charges · inpatientfrom % of charges	$336	$336	$239	71%	—	$97 – $575
17	UnitedHealthcare ppo percent of total billed charges · outpatientfrom % of charges	$336	$336	$239	71%	—	$97 – $575
18	Cigna ppo percent of total billed charges · inpatientfrom % of charges	$338	$338	$240	71%	—	$97 – $578
19	Cigna ppo percent of total billed charges · outpatientfrom % of charges	$338	$338	$240	71%	—	$97 – $578
20	Anthem ppo percent of total billed charges · inpatientfrom % of charges	$339	$339	$242	71%	—	$98 – $581
21	Anthem ppo percent of total billed charges · outpatientfrom % of charges	$339	$339	$242	71%	—	$98 – $581

Last updated: Nov 21, 2025

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