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
GRAFTJACKET DERM TISS SQCM-457 (HIGH)
Schenectady, NY
See all hospitals reporting HCPCS Q4107 →Price type
Ellis Hospital’s median price of $266 is 23% above the median hospital's median price ($216), higher than 59% 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: 5 payers, 7 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.
Filter by billing methodology
Filter by billing class
| # | |||||||
|---|---|---|---|---|---|---|---|
| 1 | Tricare tricare facility · fee schedule · outpatient | $127 | $127 | — | — | — | $127 – $127 |
| 2 | Medicare medicare facility · fee schedule · outpatient | $155 | $155 | — | — | — | $155 – $155 |
| 3 | Blue Cross Blue Shield blue shield senior facility · fee schedule · outpatient | $162 | $162 | — | — | — | $162 – $162 |
| 4 | UnitedHealthcare united healthcare facility · percent of total billed charges · inpatientfrom % of charges | $425 | $425 | — | — | — | $425 – $425 |
| 5 | UnitedHealthcare united healthcare facility · percent of total billed charges · outpatientfrom % of charges | $425 | $425 | — | — | — | $425 – $425 |
| 6 | Aetna aetna facility · percent of total billed charges · outpatientfrom % of charges | $441 | $441 | — | — | — | $441 – $441 |
| 7 | Aetna aetna facility · percent of total billed charges · inpatientfrom % of charges | $451 | $451 | — | — | — | $451 – $451 |
Last updated: Jun 25, 2026
See Graftjacket regenerative tissue graft material pricing across every hospital in the network reporting it, or ask Claude or any MCP client directly — see how to connect.