Revitalon skin substitute, per square centimeter 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

Revitalon 1 square cm

Maple Grove, MN

See all hospitals reporting HCPCS Q4157 →

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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 $348 is 71% above the median hospital's median price ($203), higher than 83% of the 838 hospitals reporting HCPCS Q4157. The highlighted bar is where this hospital falls; shaded is the middle 50% of hospitals.

Payers reporting HCPCS Q4157 at Fairview Maple Grove Surgery Center

Negotiated rates from the hospital’s own file: 3 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	Blue Cross Blue Shield medicaid fee schedule · outpatient	$211	$211	—	—	—	$211 – $211
2	Medica ma non-snp fee schedule · both	$215	$215	—	—	—	$215 – $215
3	Medica ma snp fee schedule · both	$215	$215	—	—	—	$215 – $215
4	Medica prime solution fee schedule · both	$215	$215	—	—	—	$215 – $215
5	Medica vantage fee schedule · both	$215	$215	—	—	—	$215 – $215
6	Blue Cross Blue Shield federal fee schedule · outpatient	$348	$348	—	—	—	$348 – $348
7	Blue Cross Blue Shield commercial fee schedule · outpatient	$354	$354	—	—	—	$354 – $354
8	UnitedHealthcare commercial fee schedule · both	$368	$368	—	—	—	$368 – $368
9	Medica bold fee schedule · both	$383	$383	—	—	—	$383 – $383
10	Medica choice without / elect fee schedule · both	$425	$425	—	—	—	$425 – $425
11	Medica city of st paul / essential uplan fee schedule · both	$425	$425	—	—	—	$425 – $425
12	Medica choice with fee schedule · both	$440	$440	—	—	—	$440 – $440

Last updated: May 18, 2026

Compare to other hospitals

See Revitalon skin substitute, per square centimeter pricing across every hospital in the network reporting it, or ask Claude or any MCP client directly — see how to connect.