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
SURGIGRAFT PER SQ CM LVL 2
Duluth, GA
See all hospitals reporting HCPCS Q4183 →Price type
Northside Hospital, Inc.’s median price of $197 is 23% above the median hospital's median price ($160), higher than 60% of the 857 hospitals reporting HCPCS Q4183. The highlighted bar is where this hospital falls; shaded is the middle 50% of hospitals.
Negotiated rates from the hospital’s own file: 10 payers, 62 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 | Caresource caresource other · outpatient | $53 | $53 | $28 | 52% | — | $26 – $81 |
| 2 | Cigna cigna healthsprings medicare advantage other · outpatient | $71 | $71 | $37 | 52% | — | $34 – $108 |
| 3 | Blue Cross Blue Shield bcbs_pathway other · outpatient | $75 | $75 | $39 | 52% | — | $36 – $114 |
| 4 | Blue Cross Blue Shield bcbs_pathway-l other · outpatient | $75 | $75 | $39 | 52% | — | $36 – $114 |
| 5 | Blue Cross Blue Shield blue hpn other · outpatient | $116 | $116 | $60 | 52% | — | $56 – $176 |
| 6 | Blue Cross Blue Shield blue hpn-l other · outpatient | $116 | $116 | $60 | 52% | — | $56 – $176 |
| 7 | Tricare tricare fee schedule · outpatient | $127 | $127 | — | — | — | $127 – $127 |
| 8 | Blue Cross Blue Shield bcbs_hmo other · outpatient | $151 | $151 | $78 | 52% | — | $72 – $229 |
| 9 | Blue Cross Blue Shield bcbs_hmo-l other · outpatient | $151 | $151 | $78 | 52% | — | $72 – $229 |
| 10 | Caresource caresource marketplace percent of total billed charges · inpatientfrom % of charges | $153 | $153 | $80 | 52% | — | $73 – $233 |
| 11 | Caresource caresource marketplace percent of total billed charges · outpatientfrom % of charges | $153 | $153 | $80 | 52% | — | $73 – $233 |
| 12 | Blue Cross Blue Shield bcbs_ppo other · outpatient | $178 | $178 | $93 | 52% | — | $85 – $271 |
| 13 | Blue Cross Blue Shield bcbs_ppo-l other · outpatient | $178 | $178 | $93 | 52% | — | $85 – $271 |
| 14 | Aetna aetna whole health percent of total billed charges · outpatientfrom % of charges | $206 | $206 | $107 | 52% | — | $99 – $313 |
| 15 | Aetna aetna whole health-g percent of total billed charges · outpatientfrom % of charges | $206 | $206 | $107 | 52% | — | $99 – $313 |
| 16 | Oscar oscar percent of total billed charges · inpatientfrom % of charges | $206 | $206 | $107 | 52% | — | $99 – $313 |
| 17 | Oscar oscar percent of total billed charges · outpatientfrom % of charges | $206 | $206 | $107 | 52% | — | $99 – $313 |
| 18 | Cigna cigna other · outpatient | $259 | $259 | $135 | 52% | — | $124 – $394 |
| 19 | Cigna cigna-g other · outpatient | $259 | $259 | $135 | 52% | — | $124 – $394 |
| 20 | Cigna cigna-h other · outpatient | $259 | $259 | $135 | 52% | — | $124 – $394 |
| 21 | Cigna cigna-l other · outpatient | $259 | $259 | $135 | 52% | — | $124 – $394 |
| 22 | Kaiser kaiser_hmo percent of total billed charges · outpatientfrom % of charges | $267 | $267 | $139 | 52% | — | $128 – $406 |
| 23 | Kaiser kaiser_hmo-aga percent of total billed charges · outpatientfrom % of charges | $267 | $267 | $139 | 52% | — | $128 – $406 |
| 24 | Kaiser kaiser_hmo-bariatric percent of total billed charges · outpatientfrom % of charges | $267 | $267 | $139 | 52% | — | $128 – $406 |
| 25 | Kaiser kaiser_hmo-gcs percent of total billed charges · outpatientfrom % of charges | $267 | $267 | $139 | 52% | — | $128 – $406 |
Last updated: Feb 14, 2026
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