Graftjacket regenerative tissue graft material at Mount Carmel East

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.

Model: claude-haiku-5-5
Provider: anthropic
API: message_batches
Reasoning effort: low
Max output tokens: 4096
Prompt version (hash): 444523875572
Generated: October 20, 2026

Original text from hospital filings

TISSUE GRAFTJACKET NOW STD 4X4CM-Q4107-COST PER SQ CM

Columbus, OH

See all hospitals reporting HCPCS Q4107 →

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Pricing by billing methodology

Price type

How this price compares nationally

Mount Carmel East’s median price of $160 is 26% below the median hospital's median price ($216), higher than 36% of the 1,589 hospitals reporting HCPCS Q4107. The highlighted bar is where this hospital falls; shaded is the middle 50% of hospitals.

Payers reporting HCPCS Q4107 at Mount Carmel East

Negotiated rates from the hospital’s own file: 21 payers, 32 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	Aetna aetna medicare advantage facility · percent of total billed charges · bothfrom % of charges	$62	$69	$19	28%	—	$52 – $112
2	Molina molina medicare advantage facility · percent of total billed charges · bothfrom % of charges	$100	$111	$31	28%	—	$83 – $180
3	Anthem anthem bcbs pathway hmo facility · percent of total billed charges · bothfrom % of charges	$107	$119	$33	28%	—	$89 – $192
4	Aetna aetna asa meritain facility · percent of total billed charges · bothfrom % of charges	$128	$143	$39	28%	—	$107 – $231
5	Medical Mutual medical mutual medflex facility · percent of total billed charges · bothfrom % of charges	$132	$147	$41	28%	—	$110 – $238
6	Medical Mutual medical mutual oh supermed ppo pos hmo facility · percent of total billed charges · bothfrom % of charges	$132	$147	$41	28%	—	$110 – $238
7	Medcost cofinity facility · percent of total billed charges · bothfrom % of charges	$134	$149	$41	28%	—	$111 – $241
8	Aetna aetna neighborhood narrow network facility · percent of total billed charges · bothfrom % of charges	$140	$156	$43	28%	—	$117 – $253
9	UnitedHealthcare united healthcare ppo facility · percent of total billed charges · bothfrom % of charges	$145	$161	$44	28%	—	$120 – $261
10	Humana choice care humana facility · percent of total billed charges · bothfrom % of charges	$146	$163	$45	28%	—	$121 – $263
11	Humana humana one facility · percent of total billed charges · bothfrom % of charges	$146	$163	$45	28%	—	$121 – $263
12	Anthem anthem bcbs pathway grp hmo facility · percent of total billed charges · bothfrom % of charges	$149	$165	$46	28%	—	$123 – $268
13	First Health aetna first health facility · percent of total billed charges · bothfrom % of charges	$151	$168	$46	28%	—	$125 – $271
14	UnitedHealthcare united healthcare exchange facility · percent of total billed charges · bothfrom % of charges	$158	$176	$49	28%	—	$131 – $285
15	Cigna cigna facility · percent of total billed charges · bothfrom % of charges	$160	$178	$49	28%	—	$133 – $289
16	Anthem anthem blue access ppo blue pref hmo facility · percent of total billed charges · bothfrom % of charges	$171	$190	$52	28%	—	$141 – $307
17	Blue Cross Blue Shield anthem blue access ppo blue pref hmo facility · percent of total billed charges · bothfrom % of charges	$171	$190	$52	28%	—	$141 – $307
18	Carefirst anthem blue access ppo blue pref hmo facility · percent of total billed charges · bothfrom % of charges	$171	$190	$52	28%	—	$141 – $307
19	Excellus anthem blue access ppo blue pref hmo facility · percent of total billed charges · bothfrom % of charges	$171	$190	$52	28%	—	$141 – $307
20	Highmark anthem blue access ppo blue pref hmo facility · percent of total billed charges · bothfrom % of charges	$171	$190	$52	28%	—	$141 – $307
21	Premera anthem blue access ppo blue pref hmo facility · percent of total billed charges · bothfrom % of charges	$171	$190	$52	28%	—	$141 – $307
22	Regence anthem blue access ppo blue pref hmo facility · percent of total billed charges · bothfrom % of charges	$171	$190	$52	28%	—	$141 – $307
23	Wellmark anthem blue access ppo blue pref hmo facility · percent of total billed charges · bothfrom % of charges	$171	$190	$52	28%	—	$141 – $307
24	Oscar oscar facility · percent of total billed charges · bothfrom % of charges	$172	$191	$53	28%	—	$142 – $309
25	Caresource caresource marketplace facility · percent of total billed charges · bothfrom % of charges	$209	$232	$64	28%	—	$173 – $376

Page 1 of 2 · 32 rates

Last updated: Mar 31, 2026

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