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
GRFTJKT XP 2CC 1605X-2087
Folsom, CA
See all hospitals reporting HCPCS Q4113 →Price type
Dignity Health’s median price of $4.2k is 109% above the median hospital's median price ($2.0k), higher than 82% 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: 9 payers, 35 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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Filter by billing class
| # | |||||||
|---|---|---|---|---|---|---|---|
| 1 | UnitedHealthcare medicaid|< 21 fee schedule · outpatient | $311 | $311 | — | — | — | $311 – $311 |
| 2 | UnitedHealthcare medicaid|> 21 fee schedule · outpatient | $311 | $311 | — | — | — | $311 – $311 |
| 3 | Molina medicaid|all plans fee schedule · outpatient | $585 | $585 | — | — | — | $585 – $585 |
| 4 | Anthem medicaid|all plans fee schedule · outpatient | $592 | $592 | — | — | — | $592 – $592 |
| 5 | Anthem commercial|connection epo fee schedule · outpatient | $814 | $814 | — | — | — | $814 – $814 |
| 6 | Anthem commercial|all other plans fee schedule · outpatient | $1.0k | $1.0k | — | — | — | $1.0k – $1.0k |
| 7 | Anthem commercial|mcs fee schedule · outpatient | $1.4k | $1.4k | — | — | — | $1.4k – $1.4k |
| 8 | Cigna commercial|localplus fee schedule · outpatient | $1.8k | $1.8k | — | — | — | $1.8k – $1.8k |
| 9 | Cigna commercial|all other plans fee schedule · outpatient | $2.4k | $2.4k | — | — | — | $2.4k – $2.4k |
| 10 | Kaiser commercial|all plans fee schedule · inpatient | $2.4k | $2.4k | — | — | — | $2.4k – $2.4k |
| 11 | Kaiser medicaid|all plans fee schedule · inpatient | $2.4k | $2.4k | — | — | — | $2.4k – $2.4k |
| 12 | Kaiser medicare|all plans fee schedule · inpatient | $2.4k | $2.4k | — | — | — | $2.4k – $2.4k |
| 13 | Anthem medicaid|all plans fee schedule · inpatient | $2.5k | $2.5k | — | — | — | $2.5k – $2.5k |
| 14 | Molina medicaid|all plans fee schedule · inpatient | $2.7k | $2.7k | — | — | — | $2.7k – $2.7k |
| 15 | UnitedHealthcare commercial|all other plans fee schedule · outpatient | $3.3k | $3.3k | — | — | — | $3.3k – $3.3k |
| 16 | UnitedHealthcare commercial|hmo fee schedule · outpatient | $3.3k | $3.3k | — | — | — | $3.3k – $3.3k |
| 17 | UnitedHealthcare commercial|non-options ppo fee schedule · outpatient | $3.3k | $3.3k | — | — | — | $3.3k – $3.3k |
| 18 | Cigna commercial|localplus fee schedule · inpatient | $4.2k | $4.2k | — | — | — | $4.2k – $4.2k |
| 19 | Kaiser medicaid|all plans fee schedule · outpatient | $4.3k | $4.3k | — | — | — | $4.3k – $4.3k |
| 20 | Cigna commercial|all other plans fee schedule · inpatient | $5.5k | $5.5k | — | — | — | $5.5k – $5.5k |
| 21 | Blue Cross Blue Shield commercial|aco trio fee schedule · inpatient | $7.3k | $7.3k | — | — | — | $7.3k – $7.3k |
| 22 | First Health commercial|all plans fee schedule · inpatient | $7.8k | $7.8k | — | — | — | $7.8k – $7.8k |
| 23 | First Health commercial|all plans fee schedule · outpatient | $7.8k | $7.8k | — | — | — | $7.8k – $7.8k |
| 24 | Kaiser commercial|all plans fee schedule · outpatient | $8.2k | $8.2k | — | — | — | $8.2k – $8.2k |
| 25 | MultiPlan commercial|all plans fee schedule · inpatient | $8.6k | $8.6k | — | — | — | $8.6k – $8.6k |
Last updated: Feb 28, 2026
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