Skin graft substitute material at Fairview Maple Grove Surgery Center

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

Memoderm/derma/tranz/integup

Maple Grove, MN

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Pricing by billing methodology

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How this price compares nationally

Fairview Maple Grove Surgery Center’s median price of $95 is 32% below the median hospital's median price ($139), higher than 22% of the 1,138 hospitals reporting HCPCS Q4126. The highlighted bar is where this hospital falls; shaded is the middle 50% of hospitals.

Payers reporting HCPCS Q4126 at Fairview Maple Grove Surgery Center

Negotiated rates from the hospital’s own file: 4 payers, 15 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	Medica ma non-snp fee schedule · both	$63	$63	—	—	—	$63 – $63
2	Medica ma snp fee schedule · both	$63	$63	—	—	—	$63 – $63
3	Medica prime solution fee schedule · both	$63	$63	—	—	—	$63 – $63
4	Medica vantage fee schedule · both	$63	$63	—	—	—	$63 – $63
5	Blue Cross Blue Shield medicaid fee schedule · outpatient	$64	$64	—	—	—	$64 – $64
6	Blue Cross Blue Shield federal fee schedule · both	$78	$78	—	—	—	$78 – $78
7	Blue Cross Blue Shield commercial fee schedule · both	$80	$80	—	—	—	$80 – $80
8	Blue Cross Blue Shield federal fee schedule · outpatient	$106	$106	—	—	—	$106 – $106
9	Cigna commercial fee schedule · both	$106	$106	$9	9%	—	$97 – $116
10	Blue Cross Blue Shield commercial fee schedule · outpatient	$108	$108	—	—	—	$108 – $108
11	Medica bold fee schedule · both	$148	$148	—	—	—	$148 – $148
12	UnitedHealthcare commercial fee schedule · both	$159	$159	—	—	—	$159 – $159
13	Medica choice without / elect fee schedule · both	$164	$164	—	—	—	$164 – $164
14	Medica city of st paul / essential uplan fee schedule · both	$164	$164	—	—	—	$164 – $164
15	Medica choice with fee schedule · both	$170	$170	—	—	—	$170 – $170

Last updated: May 18, 2026

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