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
GRAFT JACKET EXPRESS, INJ 1 CC
Summit, WI
See all hospitals reporting HCPCS Q4113 →Price type
Aurora Medical Center Summit’s median price of $1.9k is 6% below the median hospital's median price ($2.0k), higher than 46% of the 1,050 hospitals reporting HCPCS Q4113. The highlighted bar is where this hospital falls; shaded is the middle 50% of hospitals.
Negotiated rates from the hospital’s own file: 6 payers, 21 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 | Aetna hmo fee schedule · outpatient | $718 | $718 | — | — | — | $718 – $718 |
| 2 | Cigna ppo-gppo fee schedule · outpatient | $1.1k | $1.1k | — | — | — | $1.1k – $1.1k |
| 3 | UnitedHealthcare charter percent of total billed charges · outpatientfrom % of charges | $1.8k | $1.8k | — | — | — | $1.8k – $1.8k |
| 4 | UnitedHealthcare exchange percent of total billed charges · outpatientfrom % of charges | $1.8k | $1.8k | — | — | — | $1.8k – $1.8k |
| 5 | UnitedHealthcare hmo percent of total billed charges · outpatientfrom % of charges | $1.8k | $1.8k | — | — | — | $1.8k – $1.8k |
| 6 | UnitedHealthcare nexus percent of total billed charges · outpatientfrom % of charges | $1.8k | $1.8k | — | — | — | $1.8k – $1.8k |
| 7 | Anthem blue priority percent of total billed charges · outpatientfrom % of charges | $1.8k | $1.8k | — | — | — | $1.8k – $1.8k |
| 8 | Healthpartners employee trust fund percent of total billed charges · outpatientfrom % of charges | $1.8k | $1.8k | — | — | — | $1.8k – $1.8k |
| 9 | Molina commercial percent of total billed charges · outpatientfrom % of charges | $1.8k | $1.8k | — | — | — | $1.8k – $1.8k |
| 10 | Anthem blue preferred percent of total billed charges · outpatientfrom % of charges | $2.0k | $2.0k | — | — | — | $2.0k – $2.0k |
| 11 | Healthpartners broad percent of total billed charges · inpatientfrom % of charges | $2.3k | $2.3k | — | — | — | $2.3k – $2.3k |
| 12 | Healthpartners broad percent of total billed charges · outpatientfrom % of charges | $2.3k | $2.3k | — | — | — | $2.3k – $2.3k |
| 13 | Healthpartners robin percent of total billed charges · outpatientfrom % of charges | $2.3k | $2.3k | — | — | — | $2.3k – $2.3k |
| 14 | Aetna ppo percent of total billed charges · inpatientfrom % of charges | $2.5k | $2.5k | — | — | — | $2.5k – $2.5k |
| 15 | Aetna ppo percent of total billed charges · outpatientfrom % of charges | $2.5k | $2.5k | — | — | — | $2.5k – $2.5k |
| 16 | UnitedHealthcare ppo percent of total billed charges · inpatientfrom % of charges | $2.5k | $2.5k | — | — | — | $2.5k – $2.5k |
| 17 | UnitedHealthcare ppo percent of total billed charges · outpatientfrom % of charges | $2.5k | $2.5k | — | — | — | $2.5k – $2.5k |
| 18 | Cigna ppo percent of total billed charges · inpatientfrom % of charges | $2.6k | $2.6k | — | — | — | $2.6k – $2.6k |
| 19 | Cigna ppo percent of total billed charges · outpatientfrom % of charges | $2.6k | $2.6k | — | — | — | $2.6k – $2.6k |
| 20 | Anthem ppo percent of total billed charges · inpatientfrom % of charges | $2.6k | $2.6k | — | — | — | $2.6k – $2.6k |
| 21 | Anthem ppo percent of total billed charges · outpatientfrom % of charges | $2.6k | $2.6k | — | — | — | $2.6k – $2.6k |
Last updated: Nov 21, 2025
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