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
MATRIX 4 X 5 WOUND BILAYER
Boulder, CO
See all hospitals reporting HCPCS Q4104 →Price type
Boulder Community Health’s median price of $5.5k is 3949% above the median hospital's median price ($136), higher than 86% of the 1,723 hospitals reporting HCPCS Q4104. The highlighted bar is where this hospital falls; shaded is the middle 50% of hospitals.
Negotiated rates from the hospital’s own file: 9 payers, 38 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 | Cigna commercial facility · fee schedule · outpatient | $50 | $50 | — | — | — | $50 – $50 |
| 2 | Anthem commercial professional · fee schedule · both | $51 | $51 | — | — | — | $51 – $51 |
| 3 | Anthem managed care professional · fee schedule · both | $51 | $51 | — | — | — | $51 – $51 |
| 4 | UnitedHealthcare commercial professional · fee schedule · both | $54 | $54 | — | — | — | $54 – $54 |
| 5 | Aetna medicare advantage professional · fee schedule · both | $57 | $57 | — | — | — | $57 – $57 |
| 6 | Aetna commercial professional · fee schedule · both | $82 | $82 | $25 | 31% | — | $57 – $107 |
| 7 | Cigna commercial professional · fee schedule · both | $127 | $127 | — | — | — | $127 – $127 |
| 8 | UnitedHealthcare medicare advantage professional · fee schedule · both | $130 | $130 | $3 | 2% | — | $127 – $133 |
| 9 | Aetna medicare advantage facility · case rate · outpatient | $133 | $133 | — | — | — | $133 – $133 |
| 10 | Anthem medicare advantage facility · case rate · outpatient | $133 | $133 | — | — | — | $133 – $133 |
| 11 | Humana medicare advantage facility · case rate · outpatient | $135 | $135 | — | — | — | $135 – $135 |
| 12 | UnitedHealthcare medicare advantage facility · case rate · outpatient | $135 | $135 | — | — | — | $135 – $135 |
| 13 | Anthem medicare advantage professional · fee schedule · both | $135 | $135 | — | — | — | $135 – $135 |
| 14 | Devoted medicare advantage professional · fee schedule · both | $135 | $135 | — | — | — | $135 – $135 |
| 15 | Humana medicare advantage professional · fee schedule · both | $135 | $135 | — | — | — | $135 – $135 |
| 16 | Kaiser medicare advantage facility · case rate · outpatient | $136 | $136 | $1 | 0% | — | $135 – $137 |
| 17 | Devoted medicare advantage facility · case rate · outpatient | $137 | $137 | — | — | — | $137 – $137 |
| 18 | Kaiser medicare advantage professional · fee schedule · both | $168 | $168 | — | — | — | $168 – $168 |
| 19 | Kaiser commercial professional · fee schedule · both | $214 | $214 | — | — | — | $214 – $214 |
| 20 | Anthem commercial facility · fee schedule · outpatient | $330 | $490 | $341 | 70% | — | $261 – $1.2k |
| 21 | Anthem managed care facility · fee schedule · outpatient | $529 | $529 | — | — | — | $529 – $529 |
| 22 | Kaiser commercial facility · percent of total billed charges · inpatientfrom % of charges | $5.9k | $5.9k | $414 | 7% | — | $5.5k – $6.3k |
| 23 | Kaiser commercial facility · percent of total billed charges · outpatientfrom % of charges | $5.9k | $5.9k | $414 | 7% | — | $5.5k – $6.3k |
| 24 | Kaiser managed care facility · percent of total billed charges · inpatientfrom % of charges | $6.3k | $6.3k | — | — | — | $6.3k – $6.3k |
| 25 | Kaiser managed care facility · percent of total billed charges · outpatientfrom % of charges | $6.3k | $6.3k | — | — | — | $6.3k – $6.3k |
Last updated: Sep 16, 2026
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