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
Restorigin 1 sq cm
Maple Grove, MN
See all hospitals reporting HCPCS Q4191 →Price type
Fairview Maple Grove Surgery Center’s median price of $1.2k is 213% above the median hospital's median price ($369), higher than 75% of the 917 hospitals reporting HCPCS Q4191. The highlighted bar is where this hospital falls; shaded is the middle 50% of hospitals.
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 | Blue Cross Blue Shield federal fee schedule · outpatient | $348 | $348 | — | — | — | $348 – $348 |
| 3 | Blue Cross Blue Shield commercial fee schedule · outpatient | $354 | $354 | — | — | — | $354 – $354 |
| 4 | Medica ma non-snp fee schedule · both | $1.1k | $1.1k | — | — | — | $1.1k – $1.1k |
| 5 | Medica ma snp fee schedule · both | $1.1k | $1.1k | — | — | — | $1.1k – $1.1k |
| 6 | Medica prime solution fee schedule · both | $1.1k | $1.1k | — | — | — | $1.1k – $1.1k |
| 7 | Medica vantage fee schedule · both | $1.1k | $1.1k | — | — | — | $1.1k – $1.1k |
| 8 | Blue Cross Blue Shield federal fee schedule · both | $1.5k | $1.5k | — | — | — | $1.5k – $1.5k |
| 9 | Blue Cross Blue Shield commercial fee schedule · both | $1.6k | $1.6k | — | — | — | $1.6k – $1.6k |
| 10 | Cigna commercial fee schedule · both | $1.8k | $1.8k | $159 | 9% | — | $1.7k – $2.0k |
| 11 | UnitedHealthcare commercial fee schedule · both | $2.3k | $2.3k | — | — | — | $2.3k – $2.3k |
| 12 | Medica bold fee schedule · both | $2.9k | $2.9k | — | — | — | $2.9k – $2.9k |
| 13 | Medica choice without / elect fee schedule · both | $3.2k | $3.2k | — | — | — | $3.2k – $3.2k |
| 14 | Medica city of st paul / essential uplan fee schedule · both | $3.2k | $3.2k | — | — | — | $3.2k – $3.2k |
| 15 | Medica choice with fee schedule · both | $3.3k | $3.3k | — | — | — | $3.3k – $3.3k |
Last updated: May 18, 2026
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