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
Grftjacket Xpress Floable Sft Tissue per Cc
Smith, AR
See all hospitals reporting HCPCS Q4113 →Price type
Mercy Hospital Fort Smith’s median price of $2.0k is about the same as the median hospital's median price ($2.0k), higher than 49% of the 1,053 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: 7 payers, 9 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 | Medicaid hb ftsm ark medicaid facility · fee schedule · outpatient | $311 | $311 | — | — | — | $311 – $311 |
| 2 | Caresource hb ftsm caresource medicaid facility · fee schedule · outpatient | $318 | $318 | — | — | — | $318 – $318 |
| 3 | Aetna hb ftsm ok managed medicaid facility · percent of total billed charges · outpatientfrom % of charges | $968 | $968 | — | — | — | $968 – $968 |
| 4 | Humana hb ftsm ok managed medicaid facility · percent of total billed charges · outpatientfrom % of charges | $968 | $968 | — | — | — | $968 – $968 |
| 5 | Cigna hb ftsm cigna facility · percent of total billed charges · outpatientfrom % of charges | $1.9k | $1.9k | — | — | — | $1.9k – $1.9k |
| 6 | Aetna hb ftsm coventry/aetna facility · percent of total billed charges · outpatientfrom % of charges | $2.1k | $2.1k | — | — | — | $2.1k – $2.1k |
| 7 | First Health hb ftsm first health_ccn facility · percent of total billed charges · outpatientfrom % of charges | $2.1k | $2.1k | — | — | — | $2.1k – $2.1k |
| 8 | Humana hb ftsm humana facility · percent of total billed charges · outpatientfrom % of charges | $2.9k | $2.9k | — | — | — | $2.9k – $2.9k |
| 9 | MultiPlan hb ftsm,wldar,ozkar,prsar multi plan facility · percent of total billed charges · outpatientfrom % of charges | $3.3k | $3.3k | — | — | — | $3.3k – $3.3k |
Last updated: Jun 8, 2026
See GraftJacket Xpress injectable tissue matrix, per cc pricing across every hospital in the network reporting it, or ask Claude or any MCP client directly — see how to connect.