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
GRAFT TISSUE ACELLULAR DERMIS FROZEN REGENERATIVE STERILE THERASKIN 3X6IN
Rochester, MN
See all hospitals reporting HCPCS Q4121 →Price type
Mayo Clinic’s median price of $7.4k is 5561% above the median hospital's median price ($130), higher than 100% of the 1,620 hospitals reporting HCPCS Q4121. The highlighted bar is where this hospital falls; shaded is the middle 50% of hospitals.
Negotiated rates from the hospital’s own file: 18 payers, 64 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 pps medicaid bcbs [1146] facility · fee schedule · both | $136 | $136 | — | — | — | $136 – $136 |
| 2 | Blue Cross Blue Shield blue cross blue shield medicare advantage plan aco southern [1123] facility · fee schedule · both | $144 | $144 | — | — | — | $144 – $144 |
| 3 | Blue Cross Blue Shield blue cross blue shield medicare advantage plan ppo [826] facility · fee schedule · both | $144 | $144 | — | — | — | $144 – $144 |
| 4 | Optum veteran affairs optum [1045] facility · other · both | $144 | $144 | — | — | — | $144 – $144 |
| 5 | Ucare ucare connect+ medicare advantage plan [1116] facility · other · both | $147 | $147 | — | — | — | $147 – $147 |
| 6 | Medica medica advantage solution by county medicare advantage plan [793] facility · other · both | $148 | $148 | — | — | — | $148 – $148 |
| 7 | Blue Cross Blue Shield blue cross blue shield medicare advantage plan msho [228] facility · other · both | $151 | $151 | — | — | — | $151 – $151 |
| 8 | UnitedHealthcare united healthcare medicare advantage plan [1249] facility · other · both | $155 | $155 | — | — | — | $155 – $155 |
| 9 | Medica medica advantage solution medicare advantage plan [1206] facility · other · both | $158 | $158 | — | — | — | $158 – $158 |
| 10 | Ucare ucare essentia care medicare advantage plan [779] facility · other · both | $158 | $158 | — | — | — | $158 – $158 |
| 11 | Humana transplant humana medicare advantage plan [1002] facility · other · both | $165 | $165 | — | — | — | $165 – $165 |
| 12 | Blue Cross Blue Shield medicaid base apr drg only [1276] facility · percent of total billed charges · bothfrom % of charges | $1.6k | $1.6k | — | — | — | $1.6k – $1.6k |
| 13 | Blue Cross Blue Shield medicaid base apr drg only [1277] facility · percent of total billed charges · bothfrom % of charges | $1.6k | $1.6k | — | — | — | $1.6k – $1.6k |
| 14 | Healthpartners medicaid cah healthpartners [1174] facility · percent of total billed charges · bothfrom % of charges | $1.6k | $1.6k | — | — | — | $1.6k – $1.6k |
| 15 | Molina medicaid base apr drg only [1276] facility · percent of total billed charges · bothfrom % of charges | $1.6k | $1.6k | — | — | — | $1.6k – $1.6k |
| 16 | Ucare medicaid base apr drg only [1276] facility · percent of total billed charges · bothfrom % of charges | $1.6k | $1.6k | — | — | — | $1.6k – $1.6k |
| 17 | Ucare pps medicaid ucare [1184] facility · percent of total billed charges · bothfrom % of charges | $1.6k | $1.6k | — | — | — | $1.6k – $1.6k |
| 18 | UnitedHealthcare medicaid base apr drg only [1276] facility · percent of total billed charges · bothfrom % of charges | $1.6k | $1.6k | — | — | — | $1.6k – $1.6k |
| 19 | Medica medica medicaid [1244] facility · percent of total billed charges · bothfrom % of charges | $3.8k | $3.8k | — | — | — | $3.8k – $3.8k |
| 20 | Medica medica medicare advantage plan msho msc+ cap [167] facility · percent of total billed charges · bothfrom % of charges | $3.9k | $3.9k | — | — | — | $3.9k – $3.9k |
| 21 | Medica medicaid medica choice care msc+ [1175] facility · percent of total billed charges · bothfrom % of charges | $3.9k | $3.9k | — | — | — | $3.9k – $3.9k |
| 22 | Optum medica ma medicare advantage plan behavioral health [1350] facility · percent of total billed charges · bothfrom % of charges | $4.7k | $4.7k | — | — | — | $4.7k – $4.7k |
| 23 | Blue Cross Blue Shield blue cross blue shield aco [851] facility · percent of total billed charges · bothfrom % of charges | $6.8k | $6.8k | — | — | — | $6.8k – $6.8k |
| 24 | Ucare ucare ifp [1108] facility · percent of total billed charges · bothfrom % of charges | $6.8k | $6.8k | — | — | — | $6.8k – $6.8k |
| 25 | Blue Cross Blue Shield blue cross blue shield fep [874] facility · percent of total billed charges · bothfrom % of charges | $6.8k | $6.8k | — | — | — | $6.8k – $6.8k |
Last updated: Aug 14, 2026
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