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 25SQCM 1605X-2087
Phoenix, AZ
See all hospitals reporting HCPCS Q4107 →Price type
Dignity Health’s median price of $3.1k is 1318% above the median hospital's median price ($216), higher than 86% of the 1,589 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: 7 payers, 16 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 | Cigna commercial|exchange fee schedule · outpatient | $107 | $107 | — | — | — | $107 – $107 |
| 2 | Cigna commercial|localplus surefit fee schedule · outpatient | $114 | $114 | — | — | — | $114 – $114 |
| 3 | Cigna commercial|all other plans fee schedule · outpatient | $150 | $150 | — | — | — | $150 – $150 |
| 4 | Blue Cross Blue Shield commercial|maricopafocus fee schedule · outpatient | $504 | $504 | — | — | — | $504 – $504 |
| 5 | Blue Cross Blue Shield commercial|neighborhood fee schedule · outpatient | $504 | $504 | — | — | — | $504 – $504 |
| 6 | Blue Cross Blue Shield commercial|all other plans fee schedule · outpatient | $671 | $671 | — | — | — | $671 – $671 |
| 7 | Blue Cross Blue Shield commercial|workers comp fee schedule · outpatient | $991 | $991 | — | — | — | $991 – $991 |
| 8 | UnitedHealthcare medicaid|all plans fee schedule · outpatient | $1.1k | $1.0k | $252 | 24% | — | $618 – $1.4k |
| 9 | UnitedHealthcare commercial|dignityhealthemployee fee schedule · outpatient | $1.4k | $1.4k | $342 | 24% | — | $838 – $1.9k |
| 10 | Aetna commercial|all plans fee schedule · outpatient | $3.0k | $2.9k | $701 | 24% | — | $1.7k – $4.0k |
| 11 | Optum commercial|optumhealth fee schedule · outpatient | $3.6k | $3.5k | $845 | 24% | — | $2.1k – $4.8k |
| 12 | Cigna commercial|lifesource fee schedule · outpatient | $4.2k | $4.0k | $989 | 24% | — | $2.4k – $5.6k |
| 13 | First Health commercial|all plans fee schedule · inpatient | $5.3k | $5.1k | $1.3k | 24% | — | $3.1k – $7.1k |
| 14 | First Health commercial|all plans fee schedule · outpatient | $5.3k | $5.1k | $1.3k | 24% | — | $3.1k – $7.1k |
| 15 | MultiPlan commercial|all plans fee schedule · inpatient | $6.0k | $5.8k | $1.4k | 24% | — | $3.5k – $8.0k |
| 16 | MultiPlan commercial|all plans fee schedule · outpatient | $6.0k | $5.8k | $1.4k | 24% | — | $3.5k – $8.0k |
Last updated: Feb 28, 2026
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