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
GRAFT REVITA CLEAR 6X8CM
Pasadena, TX
See all hospitals reporting HCPCS Q4180 →Price type
Pmc Hospital, Llc’s median price of $2.4k is 506% above the median hospital's median price ($393), higher than 95% of the 1,059 hospitals reporting HCPCS Q4180. The highlighted bar is where this hospital falls; shaded is the middle 50% of hospitals.
Negotiated rates from the hospital’s own file: 8 payers, 42 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 | Cigna commercial|ppo fee schedule · outpatient | $740 | $740 | $12 | 2% | — | $728 – $752 |
| 2 | Cigna commercial|hmo fee schedule · outpatient | $760 | $760 | $33 | 4% | — | $728 – $793 |
| 3 | Cigna commercial|surefit fee schedule · outpatient | $760 | $760 | $33 | 4% | — | $728 – $793 |
| 4 | UnitedHealthcare commercial|exchange fee schedule · outpatient | $2.4k | $2.4k | — | — | — | $2.4k – $2.4k |
| 5 | Blue Cross Blue Shield commercial|exchange fee schedule · outpatient | $3.3k | $3.3k | $3.2k | 95% | — | $153 – $6.5k |
| 6 | Blue Cross Blue Shield commercial|blue premier fee schedule · outpatient | $3.5k | $3.5k | $3.3k | 95% | — | $160 – $6.8k |
| 7 | Blue Cross Blue Shield commercial|exchange fee schedule · inpatient | $3.5k | $3.5k | $3.3k | 95% | — | $160 – $6.8k |
| 8 | UnitedHealthcare commercial|charter fee schedule · outpatient | $3.6k | $3.6k | — | — | — | $3.6k – $3.6k |
| 9 | UnitedHealthcare commercial|hmo fee schedule · outpatient | $3.6k | $3.6k | — | — | — | $3.6k – $3.6k |
| 10 | UnitedHealthcare commercial|ppo fee schedule · outpatient | $3.6k | $3.6k | — | — | — | $3.6k – $3.6k |
| 11 | Blue Cross Blue Shield commercial|blue premier fee schedule · inpatient | $4.0k | $4.0k | $3.8k | 95% | — | $182 – $7.7k |
| 12 | Blue Cross Blue Shield commercial|myblue health exchange fee schedule · outpatient | $4.1k | $4.1k | $3.9k | 95% | — | $189 – $8.1k |
| 13 | UnitedHealthcare commercial|exchange fee schedule · inpatient | $4.1k | $4.1k | $3.9k | 95% | — | $189 – $8.1k |
| 14 | Aetna commercial|hmo fee schedule · inpatient | $4.0k | $4.3k | $4.1k | 96% | — | $182 – $9.0k |
| 15 | Aetna commercial|hmo fee schedule · outpatient | $4.0k | $4.3k | $4.1k | 96% | — | $182 – $9.0k |
| 16 | Blue Cross Blue Shield commercial|hmo fee schedule · outpatient | $4.3k | $4.3k | $4.1k | 95% | — | $196 – $8.4k |
| 17 | Blue Cross Blue Shield commercial|myblue health exchange fee schedule · inpatient | $4.4k | $4.4k | $4.2k | 95% | — | $204 – $8.7k |
| 18 | Aetna commercial|ppo fee schedule · inpatient | $4.6k | $4.6k | $4.4k | 95% | — | $211 – $9.0k |
| 19 | Aetna commercial|ppo fee schedule · outpatient | $4.6k | $4.6k | $4.4k | 95% | — | $211 – $9.0k |
| 20 | Blue Cross Blue Shield commercial|hmo fee schedule · inpatient | $4.6k | $4.6k | $4.4k | 95% | — | $211 – $9.0k |
| 21 | Blue Cross Blue Shield commercial|ppo fee schedule · outpatient | $4.8k | $4.8k | $4.5k | 95% | — | $218 – $9.3k |
| 22 | Cigna commercial|hmo fee schedule · inpatient | $4.8k | $4.8k | $4.5k | 95% | — | $218 – $9.3k |
| 23 | Cigna commercial|ppo fee schedule · inpatient | $4.8k | $4.8k | $4.5k | 95% | — | $218 – $9.3k |
| 24 | Cigna commercial|surefit fee schedule · inpatient | $4.8k | $4.8k | $4.5k | 95% | — | $218 – $9.3k |
| 25 | Blue Cross Blue Shield commercial|ppo fee schedule · inpatient | $4.9k | $4.9k | $4.7k | 95% | — | $226 – $9.6k |
Last updated: Feb 28, 2026
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