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
DRSG WND 10 CM X 12.5 CM 125 CM2 BILAYER
Dillon, SC
See all hospitals reporting HCPCS Q4104 →Price type
McLeod Health’s median price of $127 is 7% below the median hospital's median price ($136), higher than 40% 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: 7 payers, 11 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 | Tricare dha fee schedule · both | $51 | $51 | — | — | — | $51 – $51 |
| 2 | Blue Cross Blue Shield medicaid fee schedule · both | $99 | $99 | — | — | — | $99 – $99 |
| 3 | Medicaid medicaid fee schedule · both | $99 | $99 | — | — | — | $99 – $99 |
| 4 | Molina medicaid fee schedule · both | $104 | $104 | — | — | — | $104 – $104 |
| 5 | Cigna commercial fee schedule · both | $127 | $127 | — | — | — | $127 – $127 |
| 6 | Blue Cross Blue Shield hix percent of total billed charges · bothfrom % of charges | $5.9k | $6.0k | $1.2k | 20% | — | $4.5k – $7.8k |
| 7 | Blue Cross Blue Shield state percent of total billed charges · bothfrom % of charges | $7.3k | $7.5k | $1.5k | 20% | — | $5.7k – $9.7k |
| 8 | Blue Cross Blue Shield preferred percent of total billed charges · bothfrom % of charges | $8.4k | $8.6k | $1.7k | 20% | — | $6.5k – $11.1k |
| 9 | Blue Cross Blue Shield choice percent of total billed charges · bothfrom % of charges | $10.1k | $10.3k | $2.1k | 20% | — | $7.8k – $13.3k |
| 10 | UnitedHealthcare commercial percent of total billed charges · bothfrom % of charges | $11.5k | $11.7k | $2.3k | 20% | — | $8.8k – $15.1k |
| 11 | Aetna commercial percent of total billed charges · bothfrom % of charges | $11.8k | $12.0k | $2.4k | 20% | — | $9.1k – $15.5k |
Last updated: Jul 20, 2026
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