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 Q4180) REVITA, PER SQ CM
Low
$0
Average
$321
Median
$157
High
$2.5k
Each hospital's average Molina rate, under the methodology and billing class chosen below.
200 hospitals; the 90th percentile is 6.7× 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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248 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 | AMH Cath Labs LLC Arlington, TX case rate · outpatient | 1 | $131 | $131 | — | — | — | $131 – $131 |
| 2 | Adena Fayette Medical Center Washington Court House, OH facility · case rate · outpatient | 1 | $261 | $261 | — | — | — | $261 – $261 |
| 3 | Adena Health System Chillicothe, OH facility · fee schedule · outpatient | 2 | $181 | $181 | $62 | 34% | — | $119 – $244 |
| 4 | Agnesian Healthcare Inc. Fond Du Lac, WI fee schedule · outpatient | 1 | $92 | $92 | — | — | — | $92 – $92 |
| 5 | Amisub of South Carolina, Inc. Fort Mill, SC fee schedule · outpatient | 1 | $1.0k | $1.0k | — | — | — | $1.0k – $1.0k |
| 6 | AnMed Health Anderson, SC facility · fee schedule · outpatient | 1 | $482 | $482 | — | — | — | $482 – $482 |
| 7 | AnMed Health Cannon Pickens, SC facility · fee schedule · outpatient | 1 | $900 | $900 | — | — | — | $900 – $900 |
| 8 | AnMed Piedmont Piedmont, SC facility · fee schedule · outpatient | 1 | $482 | $482 | — | — | — | $482 – $482 |
| 9 | BAKERSFIELD MEMORIAL HOSPITAL Bakersfield, CA fee schedule · outpatient | 1 | $166 | $166 | — | — | — | $166 – $166 |
| 10 | Baylor Scott & White Medical Center - Centennial Frisco, TX facility · fee schedule · outpatient | 1 | $131 | $131 | — | — | — | $131 – $131 |
| 11 | Baylor Scott & White Medical Center - Lake Pointe Rowlett, TX facility · fee schedule · outpatient | 1 | $131 | $131 | — | — | — | $131 – $131 |
| 12 | Baylor University Medical Center Dallas, TX facility · fee schedule · outpatient | 1 | $131 | $131 | — | — | — | $131 – $131 |
| 13 | Beaufort Memorial Hospital Beaufort, SC facility · fee schedule · outpatient | 1 | $1.1k | $1.1k | — | — | — | $1.1k – $1.1k |
| 14 | Beavercreek Medical Center Springfield, OH fee schedule · outpatient | 2 | $192 | $192 | $63 | 33% | — | $129 – $255 |
| 15 | CATHOLIC HEALTH INITIATIVES COLORADO West Valley City, UT fee schedule · outpatient | 2 | $196 | $196 | $69 | 35% | — | $127 – $264 |
| 16 | CATHOLIC HEALTH INITIATIVES COLORADO West Jordan, UT fee schedule · outpatient | 2 | $196 | $196 | $69 | 35% | — | $127 – $264 |
| 17 | CATHOLIC HEALTH INITIATIVES COLORADO Lehi, UT fee schedule · outpatient | 2 | $196 | $196 | $69 | 35% | — | $127 – $264 |
| 18 | CATHOLIC HEALTH INITIATIVES COLORADO Layton, UT fee schedule · outpatient | 1 | $264 | $264 | — | — | — | $264 – $264 |
| 19 | CATHOLIC HEALTH INITIATIVES COLORADO Salt Lake City, UT fee schedule · outpatient | 1 | $264 | $264 | — | — | — | $264 – $264 |
| 20 | COMMUNITY HOSPITAL OF SAN BERNARDINO San Bernardino, CA fee schedule · inpatient | 1 | $2.1k | $2.8k | $2.2k | 78% | — | $381 – $6.9k |
| 21 | COMMUNITY HOSPITAL OF SAN BERNARDINO San Bernardino, CA fee schedule · outpatient | 1 | $233 | $233 | — | — | — | $233 – $233 |
| 22 | Carle BroMenn Medical Center Normal, IL case rate · outpatient | 1 | $133 | $133 | — | — | — | $133 – $133 |
| 23 | Clallam County Public Hospital District 2 DBA Olympic Medical Center Port Angeles, WA fee schedule · outpatient | 1 | $201 | $201 | — | — | — | $201 – $201 |
| 24 | Conway Hospital, Inc. Conway, SC professional · fee schedule · outpatient | 2 | $656 | $656 | — | — | — | $656 – $656 |
| 25 | Corewell Health Farmington Hills Hospital Farmington Hills, MI facility · fee schedule · outpatient | 1 | $126 | $126 | — | — | — | $126 – $126 |
← Payers reporting HCPCS Q4180 · Snapshot 20261112T181611Z-3fa9fb76