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
HC (SUP SHELL Q4113) GRAFTJACKET XPRESS, INJECTABLE, 1 CC
Low
$4
Average
$2.2k
Median
$1.6k
High
$8.0k
Each payer's average rate across its hospitals, under the methodology and billing class chosen below.
51 payers; the 90th percentile is 5.1× the 10th. Each bar is a price range and its height is how many payers fall in it. Hover a bar, or a row in the ladder, for details.
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| # | ||||||||
|---|---|---|---|---|---|---|---|---|
| 1 | UnitedHealthcare fee schedule · outpatient · +15 other terms | 390 | $3.3k | $3.1k | $1.8k | 57% | — | $1 – $12.5k |
| 2 | Cigna fee schedule · outpatient · +16 other terms | 184 | $1.4k | $2.5k | $1.8k | 70% | — | $585 – $9.2k |
| 3 | Blue Cross Blue Shield fee schedule · outpatient · +21 other terms | 137 | $2.5k | $2.8k | $1.7k | 62% | — | $0 – $11.5k |
| 4 | Aetna fee schedule · outpatient · +19 other terms | 66 | $915 | $1.5k | $1.2k | 82% | — | $655 – $7.8k |
| 5 | Humana fee schedule · outpatient · +16 other terms | 35 | $5.4k | $3.8k | $2.1k | 54% | — | $1 – $8.3k |
| 6 | Bcbs Tx fee schedule · outpatient · +1 other terms | 30 | $4.4k | $4.0k | $1.3k | 33% | — | $1.6k – $7.0k |
| 7 | Medical Mutual facility · percent of total billed charges · bothfrom % of charges | 29 | $2.0k | $1.6k | $753 | 47% | — | $3 – $2.7k |
| 8 | Anthem facility · fee schedule · outpatient · +12 other terms | 21 | $49 | $1.7k | $1.1k | 63% | — | $48 – $3.1k |
| 9 | MultiPlan fee schedule · inpatient · +9 other terms | 17 | $8.3k | $6.7k | $3.5k | 52% | — | $1.8k – $10.9k |
| 10 | Caresource fee schedule · outpatient · +6 other terms | 15 | $208 | $197 | $220 | 111% | — | $1 – $524 |
| 11 | Medica fee schedule · outpatient · +6 other terms | 15 | $3.3k | $3.8k | $1.2k | 31% | — | $1.6k – $5.2k |
| 12 | Medcost facility · percent of total billed charges · bothfrom % of charges · +1 other terms | 14 | $1.6k | $1.2k | $660 | 54% | — | $3 – $2.3k |
| 13 | Wellmark fee schedule · outpatient · +4 other terms | 14 | $990 | $990 | — | — | — | $990 – $990 |
| 14 | Highmark fee schedule · outpatient · +7 other terms | 13 | $839 | $867 | $251 | 29% | — | $252 – $3.4k |
| 15 | Molina fee schedule · outpatient · +9 other terms | 13 | $585 | $721 | $697 | 97% | — | $1 – $3.4k |
| 16 | Baylor Scott White Health Plan facility · percent of total billed charges · inpatientfrom % of charges · +1 other terms | 12 | $1.3k | $1.3k | $106 | 8% | — | $1.2k – $1.4k |
| 17 | Bcbs Mn fee schedule · outpatient · +3 other terms | 12 | $888 | $671 | $460 | 68% | — | $1 – $1.1k |
| 18 | Bcbs Nj fee schedule · outpatient · +1 other terms | 12 | $879 | $874 | $71 | 8% | — | $745 – $913 |
| 19 | Superior Healthplan facility · percent of total billed charges · outpatientfrom % of charges · +1 other terms | 12 | $444 | $461 | $143 | 31% | — | $291 – $819 |
| 20 | Beechstreet percent of total billed charges · bothfrom % of charges · +1 other terms | 10 | $6.2k | $6.4k | $4.0k | 63% | — | $2.3k – $11.6k |
| 21 | Kaiser fee schedule · outpatient · +9 other terms | 10 | $4.0k | $3.7k | $3.0k | 83% | — | $311 – $9.5k |
| 22 | Ambetter facility · percent of total billed charges · inpatientfrom % of charges · +2 other terms | 9 | $4k | $4k | — | — | — | $4k – $4k |
| 23 | Bcbs La fee schedule · outpatient · +1 other terms | 8 | $1.0k | $1.0k | $11 | 1% | — | $990 – $1.0k |
| 24 | First Health fee schedule · inpatient · +10 other terms | 8 | $7.8k | $8.1k | $905 | 11% | — | $6.8k – $9.5k |
| 25 | Aetna Better Health fee schedule · inpatient · +4 other terms | 7 | $740 | $740 | — | — | — | $740 – $740 |
← Hospitals reporting HCPCS Q4113 · Snapshot 20261112T181611Z-3fa9fb76