Artacent AC wound graft, 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

Artacent ac 1 sq cm

Maple Grove, MN

See all hospitals reporting HCPCS Q4190 →

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Pricing by billing methodology

Price type

How this price compares nationally

Fairview Maple Grove Surgery Center’s median price of $329 is 54% above the median hospital's median price ($214), higher than 73% of the 931 hospitals reporting HCPCS Q4190. The highlighted bar is where this hospital falls; shaded is the middle 50% of hospitals.

Payers reporting HCPCS Q4190 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	Blue Cross Blue Shield medicaid fee schedule · outpatient	$211	$211	—	—	—	$211 – $211
2	Medica ma non-snp fee schedule · both	$250	$250	—	—	—	$250 – $250
3	Medica ma snp fee schedule · both	$250	$250	—	—	—	$250 – $250
4	Medica prime solution fee schedule · both	$250	$250	—	—	—	$250 – $250
5	Medica vantage fee schedule · both	$250	$250	—	—	—	$250 – $250
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	Cigna commercial fee schedule · both	$382	$382	$33	9%	—	$349 – $415
9	UnitedHealthcare commercial fee schedule · both	$431	$431	—	—	—	$431 – $431
10	Blue Cross Blue Shield federal fee schedule · both	$442	$442	—	—	—	$442 – $442
11	Blue Cross Blue Shield commercial fee schedule · both	$450	$450	—	—	—	$450 – $450
12	Medica bold fee schedule · both	$834	$834	—	—	—	$834 – $834
13	Medica choice without / elect fee schedule · both	$926	$926	—	—	—	$926 – $926
14	Medica city of st paul / essential uplan fee schedule · both	$926	$926	—	—	—	$926 – $926
15	Medica choice with fee schedule · both	$959	$959	—	—	—	$959 – $959

Last updated: May 18, 2026

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