Revita skin graft substitute, per square centimeter at Northside Hospital, Inc.

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
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Reasoning effort: low
Max output tokens: 4096
Prompt version (hash): 444523875572
Generated: October 20, 2026

Original text from hospital filings

REVITA PER SQ CM LVL 1

Duluth, GA

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Pricing by billing methodology

Price type

How this price compares nationally

Northside Hospital, Inc.’s median price of $416 is 6% above the median hospital's median price ($393), higher than 50% of the 1,059 hospitals reporting HCPCS Q4180. The highlighted bar is where this hospital falls; shaded is the middle 50% of hospitals.

Payers reporting HCPCS Q4180 at Northside Hospital, Inc.

Negotiated rates from the hospital’s own file: 10 payers, 65 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	Caresource caresource other · outpatient	$86	$86	$31	37%	—	$54 – $117
2	Cigna cigna healthsprings medicare advantage other · outpatient	$114	$114	$42	37%	—	$72 – $156
3	Blue Cross Blue Shield bcbs_pathway other · outpatient	$120	$120	$44	37%	—	$76 – $164
4	Blue Cross Blue Shield bcbs_pathway-l other · outpatient	$120	$120	$44	37%	—	$76 – $164
5	Tricare tricare fee schedule · outpatient	$127	$127	—	—	—	$127 – $127
6	Blue Cross Blue Shield blue hpn other · outpatient	$185	$185	$68	37%	—	$117 – $253
7	Blue Cross Blue Shield blue hpn-l other · outpatient	$185	$185	$68	37%	—	$117 – $253
8	Blue Cross Blue Shield bcbs_hmo other · outpatient	$241	$241	$88	37%	—	$152 – $329
9	Blue Cross Blue Shield bcbs_hmo-l other · outpatient	$241	$241	$88	37%	—	$152 – $329
10	Caresource caresource marketplace percent of total billed charges · inpatientfrom % of charges	$245	$245	$90	37%	—	$155 – $334
11	Caresource caresource marketplace percent of total billed charges · outpatientfrom % of charges	$245	$245	$90	37%	—	$155 – $334
12	Blue Cross Blue Shield bcbs_ppo other · outpatient	$285	$285	$105	37%	—	$180 – $390
13	Blue Cross Blue Shield bcbs_ppo-l other · outpatient	$285	$285	$105	37%	—	$180 – $390
14	Aetna aetna whole health percent of total billed charges · outpatientfrom % of charges	$329	$329	$121	37%	—	$208 – $450
15	Aetna aetna whole health-g percent of total billed charges · outpatientfrom % of charges	$329	$329	$121	37%	—	$208 – $450
16	Oscar oscar percent of total billed charges · inpatientfrom % of charges	$329	$329	$121	37%	—	$208 – $450
17	Oscar oscar percent of total billed charges · outpatientfrom % of charges	$329	$329	$121	37%	—	$208 – $450
18	Cigna cigna other · outpatient	$414	$414	$152	37%	—	$262 – $566
19	Cigna cigna-g other · outpatient	$414	$414	$152	37%	—	$262 – $566
20	Cigna cigna-h other · outpatient	$414	$414	$152	37%	—	$262 – $566
21	Cigna cigna-l other · outpatient	$414	$414	$152	37%	—	$262 – $566
22	Kaiser kaiser_hmo percent of total billed charges · outpatientfrom % of charges	$427	$427	$157	37%	—	$270 – $584
23	Kaiser kaiser_hmo-aga percent of total billed charges · outpatientfrom % of charges	$427	$427	$157	37%	—	$270 – $584
24	Kaiser kaiser_hmo-bariatric percent of total billed charges · outpatientfrom % of charges	$427	$427	$157	37%	—	$270 – $584
25	Kaiser kaiser_hmo-gcs percent of total billed charges · outpatientfrom % of charges	$427	$427	$157	37%	—	$270 – $584

Page 1 of 3 · 65 rates

Last updated: Feb 14, 2026

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