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 WOUND INTEGRA BOVINE COLLAGEN GLYCOSAMINOGLYCAN 5 CM X 5 CM BILAYER WOUND MATRIX STERILE DISPOSABLE
Amarillo, TX
See all hospitals reporting HCPCS Q4104 →Price type
BSA Hospital’s median price of $7.7k is 5597% above the median hospital's median price ($136), higher than 91% 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, 19 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 aetna better health [351001] facility · percent of total billed charges · bothfrom % of charges | $5.9k | $5.9k | $1.6k | 27% | — | $4.3k – $7.5k |
| 2 | Cigna cigna healthspring medicaid replacement [394500] facility · percent of total billed charges · bothfrom % of charges | $5.9k | $5.9k | $1.6k | 27% | — | $4.3k – $7.5k |
| 3 | Healthcare Highways hch 90 degree benefits [221013] facility · percent of total billed charges · bothfrom % of charges | $5.9k | $5.9k | $1.6k | 27% | — | $4.3k – $7.5k |
| 4 | Healthcare Highways hch broken arrow [221012] facility · percent of total billed charges · bothfrom % of charges | $5.9k | $5.9k | $1.6k | 27% | — | $4.3k – $7.5k |
| 5 | Healthcare Highways hch john soules foods [221011] facility · percent of total billed charges · bothfrom % of charges | $5.9k | $5.9k | $1.6k | 27% | — | $4.3k – $7.5k |
| 6 | UnitedHealthcare uhc comm mcaid health pla [225001] facility · percent of total billed charges · bothfrom % of charges | $5.9k | $5.9k | $1.6k | 27% | — | $4.3k – $7.5k |
| 7 | UnitedHealthcare uhc medicaid community plan [375501] facility · percent of total billed charges · bothfrom % of charges | $5.9k | $5.9k | $1.6k | 27% | — | $4.3k – $7.5k |
| 8 | Cigna cigna pantex [126003] facility · percent of total billed charges · bothfrom % of charges | $7.1k | $7.1k | $1.9k | 27% | — | $5.2k – $9.1k |
| 9 | Aetna aetna client specific [101506] facility · percent of total billed charges · bothfrom % of charges | $9.9k | $9.9k | $2.7k | 27% | — | $7.2k – $12.5k |
| 10 | Medica medica harmony [291000] facility · percent of total billed charges · bothfrom % of charges | $10.6k | $10.6k | $2.9k | 27% | — | $7.7k – $13.5k |
| 11 | Phcs freedom life [178009] facility · percent of total billed charges · bothfrom % of charges | $10.6k | $10.6k | $2.9k | 27% | — | $7.7k – $13.5k |
| 12 | Phcs phcs multiplan [178000] facility · percent of total billed charges · bothfrom % of charges | $10.6k | $10.6k | $2.9k | 27% | — | $7.7k – $13.5k |
| 13 | Cigna cigna [126008] facility · percent of total billed charges · bothfrom % of charges | $11.0k | $11.0k | $3.0k | 27% | — | $8.0k – $14.0k |
| 14 | Healthpartners healthpartners [150000] facility · percent of total billed charges · bothfrom % of charges | $11.0k | $11.0k | $3.0k | 27% | — | $8.0k – $14.0k |
| 15 | UnitedHealthcare united healthcare shared svcs [206010] facility · percent of total billed charges · bothfrom % of charges | $11.0k | $11.0k | $3.0k | 27% | — | $8.0k – $14.0k |
| 16 | Aetna american continental [101507] facility · percent of total billed charges · bothfrom % of charges | $11.4k | $11.4k | $3.1k | 27% | — | $8.3k – $14.5k |
| 17 | Aetna meritain aetna [368500] facility · percent of total billed charges · bothfrom % of charges | $11.4k | $11.4k | $3.1k | 27% | — | $8.3k – $14.5k |
| 18 | Kaiser kaiser permanete oakland ca [156000] facility · percent of total billed charges · bothfrom % of charges | $12.9k | $12.9k | $3.5k | 27% | — | $9.4k – $16.4k |
| 19 | MultiPlan international benefits administrators [168005] facility · percent of total billed charges · bothfrom % of charges | $12.9k | $12.9k | $3.5k | 27% | — | $9.4k – $16.4k |
Last updated: Feb 12, 2026
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