Derma-Gide 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

Derma-gide, 1 sq cm

Maple Grove, MN

See all hospitals reporting HCPCS Q4203 →

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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 $323 is 26% above the median hospital's median price ($256), higher than 66% of the 935 hospitals reporting HCPCS Q4203. The highlighted bar is where this hospital falls; shaded is the middle 50% of hospitals.

Payers reporting HCPCS Q4203 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	$162	$162	—	—	—	$162 – $162
2	Blue Cross Blue Shield federal fee schedule · both	$207	$207	—	—	—	$207 – $207
3	Blue Cross Blue Shield commercial fee schedule · both	$210	$210	—	—	—	$210 – $210
4	Blue Cross Blue Shield federal fee schedule · outpatient	$267	$267	—	—	—	$267 – $267
5	Blue Cross Blue Shield commercial fee schedule · outpatient	$272	$272	—	—	—	$272 – $272
6	Medica ma non-snp fee schedule · both	$318	$318	—	—	—	$318 – $318
7	Medica ma snp fee schedule · both	$318	$318	—	—	—	$318 – $318
8	Medica prime solution fee schedule · both	$318	$318	—	—	—	$318 – $318
9	Medica vantage fee schedule · both	$318	$318	—	—	—	$318 – $318
10	Cigna commercial fee schedule · both	$358	$358	$31	9%	—	$327 – $389
11	Medica bold fee schedule · both	$390	$390	—	—	—	$390 – $390
12	Medica choice without / elect fee schedule · both	$433	$433	—	—	—	$433 – $433
13	Medica city of st paul / essential uplan fee schedule · both	$433	$433	—	—	—	$433 – $433
14	Medica choice with fee schedule · both	$448	$448	—	—	—	$448 – $448
15	UnitedHealthcare commercial fee schedule · both	$529	$529	—	—	—	$529 – $529

Last updated: May 18, 2026

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