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 TISSUE OASIS L7 CM X W5 CM BURN 2 LAYER
Amarillo, TX
See all hospitals reporting HCPCS Q4102 →Price type
BSA Hospital’s median price of $1.2k is 2381% above the median hospital's median price ($49), higher than 96% of the 1,638 hospitals reporting HCPCS Q4102. The highlighted bar is where this hospital falls; shaded is the middle 50% of hospitals.
Negotiated rates from the hospital’s own file: 10 payers, 24 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 bcbs medicaid [116504] facility · percent of total billed charges · bothfrom % of charges | $190 | $191 | $153 | 80% | — | $5 – $379 |
| 2 | Blue Cross Blue Shield bcbs tx medicaid chip [116506] facility · percent of total billed charges · bothfrom % of charges | $190 | $191 | $153 | 80% | — | $5 – $379 |
| 3 | Aetna aetna better health [351001] facility · percent of total billed charges · bothfrom % of charges | $790 | $797 | $637 | 80% | — | $21 – $1.6k |
| 4 | Cigna cigna healthspring medicaid replacement [394500] facility · percent of total billed charges · bothfrom % of charges | $790 | $797 | $637 | 80% | — | $21 – $1.6k |
| 5 | Healthcare Highways hch 90 degree benefits [221013] facility · percent of total billed charges · bothfrom % of charges | $790 | $797 | $637 | 80% | — | $21 – $1.6k |
| 6 | Healthcare Highways hch broken arrow [221012] facility · percent of total billed charges · bothfrom % of charges | $790 | $797 | $637 | 80% | — | $21 – $1.6k |
| 7 | Healthcare Highways hch john soules foods [221011] facility · percent of total billed charges · bothfrom % of charges | $790 | $797 | $637 | 80% | — | $21 – $1.6k |
| 8 | UnitedHealthcare uhc comm mcaid health pla [225001] facility · percent of total billed charges · bothfrom % of charges | $790 | $797 | $637 | 80% | — | $21 – $1.6k |
| 9 | UnitedHealthcare uhc medicaid community plan [375501] facility · percent of total billed charges · bothfrom % of charges | $790 | $797 | $637 | 80% | — | $21 – $1.6k |
| 10 | UnitedHealthcare united healthcare core exclusive [206022] facility · percent of total billed charges · bothfrom % of charges | $867 | $875 | $699 | 80% | — | $23 – $1.7k |
| 11 | UnitedHealthcare uhc surest bind [206032] facility · percent of total billed charges · bothfrom % of charges | $1.2k | $1.3k | $1.0k | 80% | — | $33 – $2.5k |
| 12 | UnitedHealthcare united healthcare student svc [206012] facility · percent of total billed charges · bothfrom % of charges | $1.2k | $1.3k | $1.0k | 80% | — | $33 – $2.5k |
| 13 | Aetna aetna client specific [101506] facility · percent of total billed charges · bothfrom % of charges | $1.3k | $1.3k | $1.1k | 80% | — | $35 – $2.6k |
| 14 | Cigna cigna pantex [126003] facility · percent of total billed charges · bothfrom % of charges | $1.4k | $1.4k | $476 | 33% | — | $952 – $1.9k |
| 15 | Medica medica harmony [291000] facility · percent of total billed charges · bothfrom % of charges | $1.4k | $1.4k | $1.1k | 80% | — | $38 – $2.8k |
| 16 | Phcs freedom life [178009] facility · percent of total billed charges · bothfrom % of charges | $1.4k | $1.4k | $1.1k | 80% | — | $38 – $2.8k |
| 17 | Phcs phcs multiplan [178000] facility · percent of total billed charges · bothfrom % of charges | $1.4k | $1.4k | $1.1k | 80% | — | $38 – $2.8k |
| 18 | Cigna cigna [126008] facility · percent of total billed charges · bothfrom % of charges | $1.5k | $1.5k | $1.2k | 80% | — | $39 – $2.9k |
| 19 | Healthpartners healthpartners [150000] facility · percent of total billed charges · bothfrom % of charges | $1.5k | $1.5k | $1.2k | 80% | — | $39 – $2.9k |
| 20 | UnitedHealthcare united healthcare shared svcs [206010] facility · percent of total billed charges · bothfrom % of charges | $1.5k | $1.5k | $1.2k | 80% | — | $39 – $2.9k |
| 21 | Aetna american continental [101507] facility · percent of total billed charges · bothfrom % of charges | $1.5k | $1.5k | $1.2k | 80% | — | $41 – $3.0k |
| 22 | Aetna meritain aetna [368500] facility · percent of total billed charges · bothfrom % of charges | $1.5k | $1.5k | $1.2k | 80% | — | $41 – $3.0k |
| 23 | Kaiser kaiser permanete oakland ca [156000] facility · percent of total billed charges · bothfrom % of charges | $1.7k | $1.7k | $1.4k | 80% | — | $46 – $3.4k |
| 24 | MultiPlan international benefits administrators [168005] facility · percent of total billed charges · bothfrom % of charges | $1.7k | $1.7k | $1.4k | 80% | — | $46 – $3.4k |
Last updated: Feb 12, 2026
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