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 DRESSING BILAYER
Schenectady, NY
See all hospitals reporting HCPCS Q4104 →Price type
Ellis Hospital’s median price of $126 is 8% below the median hospital's median price ($136), higher than 39% of the 1,716 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: 5 payers, 7 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 | Medicare medicare facility · fee schedule · outpatient | $62 | $62 | — | — | — | $62 – $62 |
| 2 | Blue Cross Blue Shield blue shield senior facility · fee schedule · outpatient | $65 | $65 | — | — | — | $65 – $65 |
| 3 | Tricare tricare facility · fee schedule · outpatient | $127 | $127 | — | — | — | $127 – $127 |
| 4 | UnitedHealthcare united healthcare facility · percent of total billed charges · inpatientfrom % of charges | $879 | $773 | $507 | 66% | — | $106 – $1.3k |
| 5 | UnitedHealthcare united healthcare facility · percent of total billed charges · outpatientfrom % of charges | $879 | $773 | $507 | 66% | — | $106 – $1.3k |
| 6 | Aetna aetna facility · percent of total billed charges · outpatientfrom % of charges | $912 | $802 | $526 | 66% | — | $110 – $1.4k |
| 7 | Aetna aetna facility · percent of total billed charges · inpatientfrom % of charges | $934 | $821 | $539 | 66% | — | $112 – $1.4k |
Last updated: Jun 25, 2026
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