Graftjacket regenerative tissue graft material at AMH Cath Labs LLC

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.

Model: claude-haiku-5-5
Provider: anthropic
API: message_batches
Reasoning effort: low
Max output tokens: 4096
Prompt version (hash): 444523875572
Generated: October 20, 2026

Original text from hospital filings

GRAFTJACKET NOW THIN 2X4/8SQCM

Arlington, TX

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Pricing by billing methodology

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How this price compares nationally

AMH Cath Labs LLC’s median price of $216 is about the same as the median hospital's median price ($216), higher than 50% of the 1,589 hospitals reporting HCPCS Q4107. The highlighted bar is where this hospital falls; shaded is the middle 50% of hospitals.

Payers reporting HCPCS Q4107 at AMH Cath Labs LLC

Negotiated rates from the hospital’s own file: 9 payers, 33 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	Blue Cross Blue Shield managed medicaid percent of total billed charges · outpatientfrom % of charges	$45	$57	$33	58%	—	$10 – $161
2	UnitedHealthcare managed medicaid percent of total billed charges · outpatientfrom % of charges	$45	$57	$33	58%	—	$10 – $161
3	WellCare managed medicaid percent of total billed charges · outpatientfrom % of charges	$48	$60	$35	58%	—	$11 – $169
4	Molina managed medicaid percent of total billed charges · outpatientfrom % of charges	$49	$62	$36	58%	—	$11 – $174
5	Aetna managed medicaid percent of total billed charges · outpatientfrom % of charges	$50	$63	$37	58%	—	$11 – $177
6	Blue Cross Blue Shield medicare advantage case rate · outpatient	$125	$125	—	—	—	$125 – $125
7	Humana medicare advantage case rate · outpatient	$130	$130	—	—	—	$130 – $130
8	Humana medicare advantage ppo case rate · outpatient	$130	$130	—	—	—	$130 – $130
9	Molina medicare advantage case rate · outpatient	$131	$131	—	—	—	$131 – $131
10	WellCare medicare advantage hmo case rate · outpatient	$131	$131	—	—	—	$131 – $131
11	WellCare medicare advantage mmp case rate · outpatient	$138	$138	—	—	—	$138 – $138
12	UnitedHealthcare medicare advantage ppo case rate · outpatient	$139	$139	—	—	—	$139 – $139
13	UnitedHealthcare medicare advantage hmo case rate · outpatient	$142	$142	—	—	—	$142 – $142
14	Blue Cross Blue Shield hmo fee schedule · outpatient	$211	$211	—	—	—	$211 – $211
15	Blue Cross Blue Shield exchange fee schedule · outpatient	$216	$216	—	—	—	$216 – $216
16	Aetna whole health percent of total billed charges · inpatientfrom % of charges	$176	$222	$129	58%	—	$41 – $626
17	Blue Cross Blue Shield ppo fee schedule · outpatient	$235	$235	—	—	—	$235 – $235
18	Aetna whole health percent of total billed charges · outpatientfrom % of charges	$209	$263	$154	58%	—	$48 – $743
19	Aetna commercial percent of total billed charges · inpatientfrom % of charges	$235	$296	$172	58%	—	$54 – $834
20	UnitedHealthcare all payer percent of total billed charges · outpatientfrom % of charges	$263	$332	$193	58%	—	$61 – $936
21	Aetna commercial percent of total billed charges · outpatientfrom % of charges	$279	$351	$205	58%	—	$64 – $991
22	UnitedHealthcare ppo percent of total billed charges · outpatientfrom % of charges	$279	$351	$205	58%	—	$64 – $992
23	Cigna oap/hmo percent of total billed charges · outpatientfrom % of charges	$281	$354	$207	58%	—	$65 – $1.0k
24	Phcs ppo percent of total billed charges · outpatientfrom % of charges	$354	$446	$260	58%	—	$82 – $1.3k
25	Cigna ppo percent of total billed charges · outpatientfrom % of charges	$355	$447	$261	58%	—	$82 – $1.3k

Page 1 of 2 · 33 rates

Last updated: Apr 21, 2026

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