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.
Original text from hospital filings
OASIS ULTRA TRI-LAYER PER SQ CM
Summit, WI
See all hospitals reporting HCPCS Q4124 →Price type
Aurora Medical Center Summit’s median price of $33 is 69% below the median hospital's median price ($108), higher than 35% of the 1,421 hospitals reporting HCPCS Q4124. The highlighted bar is where this hospital falls; shaded is the middle 50% of hospitals.
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 | $11 | $11 | — | — | — | $11 – $11 |
| 2 | Healthpartners employee trust fund fee schedule · outpatient | $12 | $12 | — | — | — | $12 – $12 |
| 3 | Healthpartners robin fee schedule · outpatient | $12 | $12 | — | — | — | $12 – $12 |
| 4 | Cigna ppo-gppo fee schedule · outpatient | $15 | $15 | — | — | — | $15 – $15 |
| 5 | Molina commercial fee schedule · outpatient | $25 | $25 | — | — | — | $25 – $25 |
| 6 | UnitedHealthcare charter percent of total billed charges · outpatientfrom % of charges | $33 | $33 | — | — | — | $33 – $33 |
| 7 | UnitedHealthcare exchange percent of total billed charges · outpatientfrom % of charges | $33 | $33 | — | — | — | $33 – $33 |
| 8 | UnitedHealthcare hmo percent of total billed charges · outpatientfrom % of charges | $33 | $33 | — | — | — | $33 – $33 |
| 9 | UnitedHealthcare nexus percent of total billed charges · outpatientfrom % of charges | $33 | $33 | — | — | — | $33 – $33 |
| 10 | Anthem blue priority percent of total billed charges · outpatientfrom % of charges | $33 | $33 | — | — | — | $33 – $33 |
| 11 | Anthem blue preferred percent of total billed charges · outpatientfrom % of charges | $36 | $36 | — | — | — | $36 – $36 |
| 12 | Healthpartners broad percent of total billed charges · inpatientfrom % of charges | $41 | $41 | — | — | — | $41 – $41 |
| 13 | Healthpartners broad percent of total billed charges · outpatientfrom % of charges | $41 | $41 | — | — | — | $41 – $41 |
| 14 | Aetna ppo percent of total billed charges · inpatientfrom % of charges | $45 | $45 | — | — | — | $45 – $45 |
| 15 | Aetna ppo percent of total billed charges · outpatientfrom % of charges | $45 | $45 | — | — | — | $45 – $45 |
| 16 | UnitedHealthcare ppo percent of total billed charges · inpatientfrom % of charges | $46 | $46 | — | — | — | $46 – $46 |
| 17 | UnitedHealthcare ppo percent of total billed charges · outpatientfrom % of charges | $46 | $46 | — | — | — | $46 – $46 |
| 18 | Cigna ppo percent of total billed charges · inpatientfrom % of charges | $47 | $47 | — | — | — | $47 – $47 |
| 19 | Cigna ppo percent of total billed charges · outpatientfrom % of charges | $47 | $47 | — | — | — | $47 – $47 |
| 20 | Anthem ppo percent of total billed charges · inpatientfrom % of charges | $47 | $47 | — | — | — | $47 – $47 |
| 21 | Anthem ppo percent of total billed charges · outpatientfrom % of charges | $47 | $47 | — | — | — | $47 – $47 |
Last updated: Nov 21, 2025
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