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 5 X 5 CM
Clovis, CA
See all hospitals reporting HCPCS Q4107 →Price type
Clovis Community Medical Center’s median price of $160 is 26% below the median hospital's median price ($216), higher than 35% of the 1,583 hospitals reporting HCPCS Q4107. The highlighted bar is where this hospital falls; shaded is the middle 50% of hospitals.
Negotiated rates from the hospital’s own file: 10 payers, 28 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 medi-cal facility · fee schedule · inpatient | $96 | $96 | — | — | — | $96 – $96 |
| 2 | Molina managed medi-cal facility · fee schedule · inpatient | $96 | $96 | — | — | — | $96 – $96 |
| 3 | Aetna medicare advantage facility · case rate · inpatient | $160 | $160 | — | — | — | $160 – $160 |
| 4 | Aetna medicare hmo for chp facility · case rate · inpatient | $160 | $160 | — | — | — | $160 – $160 |
| 5 | Aetna ppo facility · case rate · inpatient | $160 | $160 | — | — | — | $160 – $160 |
| 6 | Blue Cross Blue Shield medicare advantage facility · case rate · inpatient | $160 | $160 | — | — | — | $160 – $160 |
| 7 | Cigna access (pffs) facility · case rate · inpatient | $160 | $160 | — | — | — | $160 – $160 |
| 8 | Cigna healthspring facility · case rate · inpatient | $160 | $160 | — | — | — | $160 – $160 |
| 9 | Humana medicare advantage facility · case rate · inpatient | $160 | $160 | — | — | — | $160 – $160 |
| 10 | Kaiser commercial facility · case rate · inpatient | $160 | $160 | — | — | — | $160 – $160 |
| 11 | Kaiser senior advantage medicare facility · case rate · inpatient | $160 | $160 | — | — | — | $160 – $160 |
| 12 | WellCare medicare advantage facility · case rate · inpatient | $160 | $160 | — | — | — | $160 – $160 |
| 13 | UnitedHealthcare medicare advantage facility · case rate · inpatient | $162 | $162 | — | — | — | $162 – $162 |
| 14 | Aetna medicare hmo for non-chp facility · case rate · inpatient | $168 | $168 | — | — | — | $168 – $168 |
| 15 | Blue Cross Blue Shield epn facility · fee schedule · inpatient | $202 | $202 | — | — | — | $202 – $202 |
| 16 | Aetna hmoposppo facility · fee schedule · inpatient | $279 | $284 | $98 | 35% | — | $154 – $423 |
| 17 | Aetna qualified health plan facility · fee schedule · inpatient | $283 | $287 | $99 | 35% | — | $156 – $428 |
| 18 | UnitedHealthcare hmo facility · fee schedule · inpatient | $320 | $325 | $112 | 35% | — | $176 – $485 |
| 19 | UnitedHealthcare ppo facility · fee schedule · inpatient | $320 | $325 | $112 | 35% | — | $176 – $485 |
| 20 | Cigna hmo facility · fee schedule · inpatient | $339 | $345 | $119 | 35% | — | $187 – $514 |
| 21 | Cigna ppo facility · fee schedule · inpatient | $339 | $345 | $119 | 35% | — | $187 – $514 |
| 22 | Blue Cross Blue Shield hmopos facility · fee schedule · inpatient | $341 | $346 | $120 | 35% | — | $188 – $516 |
| 23 | Blue Cross Blue Shield epoppo facility · fee schedule · inpatient | $347 | $353 | $122 | 35% | — | $191 – $526 |
| 24 | Blue Cross Blue Shield hmoppo facility · fee schedule · inpatient | $381 | $388 | $134 | 35% | — | $210 – $578 |
| 25 | Blue Cross Blue Shield exchange hmo facility · fee schedule · inpatient | $388 | $395 | $136 | 35% | — | $214 – $588 |
Last updated: Sep 11, 2026
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