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
$1
Average
$1.5k
Median
$1.6k
High
$5.4k
Each hospital's average Molina rate, under the methodology and billing class chosen below.
58 hospitals; the 90th percentile is 5.8× the 10th. Each bar is a price range and its height is how many hospitals fall in it. Hover a bar, or a row in the ladder, for details.
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75 hospital rates
iThe hospitals that file a Molina rate for this code, one row per hospital and set of terms (billing class, payment method, setting). Rates under different terms are never blended, so the terms are shown under each hospital’s name. Figures are the hospital’s averages across its plans.| # | Plans | |||||||
|---|---|---|---|---|---|---|---|---|
| 1 | ARTHUR G JAMES CANCER HOSPITAL AND RESEARCH INSTITUTE Columbus, OH per diem · inpatient | 2 | $5.4k | $5.4k | — | — | — | $5.4k – $5.4k |
| 2 | Aurora BayCare Medical Center Green Bay, WI percent of total billed charges · outpatientfrom % of charges | 1 | $1.8k | $1.8k | — | — | — | $1.8k – $1.8k |
| 3 | Aurora Medical Center Burlington Burlington, WI percent of total billed charges · outpatientfrom % of charges | 1 | $1.8k | $1.8k | — | — | — | $1.8k – $1.8k |
| 4 | Aurora Medical Center Kenosha Kenosha, WI percent of total billed charges · outpatientfrom % of charges | 1 | $1.8k | $1.8k | — | — | — | $1.8k – $1.8k |
| 5 | Aurora Medical Center Mount Pleasant Mount Pleasant, WI percent of total billed charges · outpatientfrom % of charges | 1 | $1.8k | $1.8k | — | — | — | $1.8k – $1.8k |
| 6 | Aurora Medical Center Summit Summit, WI percent of total billed charges · outpatientfrom % of charges | 1 | $1.8k | $1.8k | — | — | — | $1.8k – $1.8k |
| 7 | Aurora Medical Center Washington County Hartford, WI percent of total billed charges · outpatientfrom % of charges | 1 | $1.8k | $1.8k | — | — | — | $1.8k – $1.8k |
| 8 | Aurora St Lukes Medical Center of Aurora Health Care Metro Inc Milwaukee, WI percent of total billed charges · outpatientfrom % of charges | 1 | $1.8k | $1.8k | — | — | — | $1.8k – $1.8k |
| 9 | Aurora St Lukes South Shore of Aurora Health Care Metro Inc Cudahy, WI percent of total billed charges · outpatientfrom % of charges | 1 | $1.8k | $1.8k | — | — | — | $1.8k – $1.8k |
| 10 | Bartow Regional Medical Center Bartow, FL facility · percent of total billed charges · inpatientfrom % of charges | 1 | $2.3k | $2.3k | — | — | — | $2.3k – $2.3k |
| 11 | Bartow Regional Medical Center Bartow, FL facility · percent of total billed charges · outpatientfrom % of charges | 2 | $1.5k | $1.5k | $822 | 53% | — | $720 – $2.4k |
| 12 | Baycare Hospital Wesley Chapel Chapel, FL facility · percent of total billed charges · inpatientfrom % of charges | 1 | $2.3k | $2.3k | — | — | — | $2.3k – $2.3k |
| 13 | Baycare Hospital Wesley Chapel Chapel, FL facility · percent of total billed charges · outpatientfrom % of charges | 2 | $1.5k | $1.5k | $822 | 53% | — | $720 – $2.4k |
| 14 | CLOVIS COMMUNITY MEDICAL CENTER Clovis, CA facility · fee schedule · outpatient | 1 | $311 | $311 | — | — | — | $311 – $311 |
| 15 | COMMUNITY HOSPITAL OF SAN BERNARDINO San Bernardino, CA fee schedule · inpatient | 1 | $2.8k | $2.8k | $361 | 13% | — | $2.4k – $3.1k |
| 16 | COMMUNITY HOSPITAL OF SAN BERNARDINO San Bernardino, CA fee schedule · outpatient | 1 | $436 | $436 | — | — | — | $436 – $436 |
| 17 | Central Community Hospital Elkader, IA facility · percent of total billed charges · bothfrom % of charges | 1 | $1.5k | $1.5k | — | — | — | $1.5k – $1.5k |
| 18 | Corona Regional Medical Center Corona, CA fee schedule · both | 1 | $336 | $336 | — | — | — | $336 – $336 |
| 19 | DIGNITY COMMUNITY CARE Glendale, CA fee schedule · inpatient | 1 | $2.8k | $2.8k | $361 | 13% | — | $2.4k – $3.1k |
| 20 | DIGNITY COMMUNITY CARE Glendale, CA fee schedule · outpatient | 1 | $436 | $436 | — | — | — | $436 – $436 |
| 21 | DIGNITY COMMUNITY CARE Sacramento, CA fee schedule · inpatient | 1 | $2.7k | $2.7k | — | — | — | $2.7k – $2.7k |
| 22 | DIGNITY COMMUNITY CARE Sacramento, CA fee schedule · outpatient | 1 | $585 | $585 | — | — | — | $585 – $585 |
| 23 | DIGNITY HEALTH Carmichael, CA fee schedule · inpatient | 1 | $2.7k | $2.7k | — | — | — | $2.7k – $2.7k |
| 24 | DIGNITY HEALTH Carmichael, CA fee schedule · outpatient | 1 | $585 | $585 | — | — | — | $585 – $585 |
| 25 | DIGNITY HEALTH Folsom, CA fee schedule · inpatient | 1 | $2.7k | $2.7k | — | — | — | $2.7k – $2.7k |
← Payers reporting HCPCS Q4113 · Snapshot 20261112T181611Z-3fa9fb76