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 JCKT XPRESS 2ML FLOWABLE SCAFFOLD-Q4113-COST PER SQ CM
Troy, NY
See all hospitals reporting HCPCS Q4113 →Price type
Samaritan Hospital’s median price of $1.6k is 20% below the median hospital's median price ($2.0k), higher than 41% 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: 8 payers, 12 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 | UnitedHealthcare uhc essential plan medicaid facility · percent of total billed charges · bothfrom % of charges | $848 | $848 | — | — | — | $848 – $848 |
| 2 | UnitedHealthcare united healthcare medicaid harp chip facility · percent of total billed charges · bothfrom % of charges | $848 | $848 | — | — | — | $848 – $848 |
| 3 | Anthem empire bcbs hmo epo ppo indemnity facility · percent of total billed charges · bothfrom % of charges | $1.6k | $1.6k | — | — | — | $1.6k – $1.6k |
| 4 | Blue Cross Blue Shield empire bcbs hmo epo ppo indemnity facility · percent of total billed charges · bothfrom % of charges | $1.6k | $1.6k | — | — | — | $1.6k – $1.6k |
| 5 | UnitedHealthcare empire bcbs hmo epo ppo indemnity facility · percent of total billed charges · bothfrom % of charges | $1.6k | $1.6k | — | — | — | $1.6k – $1.6k |
| 6 | Wellmark empire bcbs hmo epo ppo indemnity facility · percent of total billed charges · bothfrom % of charges | $1.6k | $1.6k | — | — | — | $1.6k – $1.6k |
| 7 | First Health first health facility · percent of total billed charges · bothfrom % of charges | $1.7k | $1.7k | — | — | — | $1.7k – $1.7k |
| 8 | Cigna cigna facility · percent of total billed charges · bothfrom % of charges | $1.8k | $1.8k | — | — | — | $1.8k – $1.8k |
| 9 | MultiPlan beech street facility · percent of total billed charges · bothfrom % of charges | $1.9k | $1.9k | — | — | — | $1.9k – $1.9k |
| 10 | MultiPlan multiplan facility · percent of total billed charges · bothfrom % of charges | $1.9k | $1.9k | — | — | — | $1.9k – $1.9k |
| 11 | Phcs multiplan facility · percent of total billed charges · bothfrom % of charges | $1.9k | $1.9k | — | — | — | $1.9k – $1.9k |
| 12 | UnitedHealthcare united healthcare facility · percent of total billed charges · bothfrom % of charges | $2.1k | $2.1k | — | — | — | $2.1k – $2.1k |
Last updated: Mar 31, 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.