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
SURGIGRAFT PER SQ CM LVL 1
Prices here combine facility and professional fees. See them separately →Experimental
Low
$120
Average
$354
Median
$196
High
$1.7k
Filter by billing methodology
Reflects a payer-specific billing methodology not covered by the standard categories.
Showing only prices reported under the other methodology. Choose another in the filter above to change the chart. 18 hospitals; the 90th percentile is 5.9× 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.
Click a bar to filter the hospitals table to that price range.
| # | Hospital | ||||||
|---|---|---|---|---|---|---|---|
| 1 | Northside Hospital, Inc. Lawrenceville, GA | $112 | $143 | $127 | 89% | — | $30 – $625 |
| 2 | Northside Hospital, Inc. Atlanta, GA | $114 | $147 | $128 | 87% | — | $32 – $625 |
| 3 | St. Vincent's Medical Center-Clay County, Inc. Middleburg, FL | $196 | $196 | — | — | — | $196 – $196 |
| 4 | St. Luke's-St. Vincent's Healthcare, Inc. Jacksonville, FL | $196 | $196 | — | — | — | $196 – $196 |
| 5 | Nationwide Children's Hospital Columbus, OH | $1.7k | $1.7k | — | — | — | $1.7k – $1.7k |
| 6 | St. Vincent's Medical Center, Inc. (FL) Jacksonville, FL | $196 | $196 | — | — | — | $196 – $196 |
| 7 | Baton Rouge General Medical Center BATON ROUGE, LA | $365 | $365 | $304 | 83% | — | $61 – $669 |
| 8 | Methodist Hospital For Surgery Addison, TX | $130 | $148 | $37 | 25% | — | $122 – $245 |
| 9 | Northside Hospital, Inc. Cumming, GA | $88 | $140 | $132 | 94% | — | $24 – $625 |
| 10 | Ascension SE Wisconsin Hospital, Inc. Milwaukee, WI | $259 | $259 | — | — | — | $259 – $259 |
Ask Claude or any MCP client for HCPCS Q4183 pricing at a specific hospital — see how to connect.