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
ALLO DERMTHERASKIN1X2=12*NLU*
Windom, MN
See all hospitals reporting HCPCS Q4121 →Price type
Windom Area Hospital’s median price of $57 is 56% below the median hospital's median price ($130), higher than 15% of the 1,610 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: 9 payers, 20 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 | Bcbs Mn pmap facility · percent of total billed charges · inpatientfrom % of charges | $43 | $43 | — | — | — | $43 – $43 |
| 2 | Bcbs Mn pmap facility · percent of total billed charges · outpatientfrom % of charges | $43 | $43 | — | — | — | $43 – $43 |
| 3 | Blue Cross Blue Shield managed medicaid facility · percent of total billed charges · inpatientfrom % of charges | $43 | $43 | — | — | — | $43 – $43 |
| 4 | Blue Cross Blue Shield managed medicaid facility · percent of total billed charges · outpatientfrom % of charges | $43 | $43 | — | — | — | $43 – $43 |
| 5 | Aetna medicare replacement facility · percent of total billed charges · outpatientfrom % of charges | $50 | $50 | — | — | — | $50 – $50 |
| 6 | Blue Cross Blue Shield medicare replacement facility · percent of total billed charges · outpatientfrom % of charges | $50 | $50 | — | — | — | $50 – $50 |
| 7 | Humana medicare replacement facility · percent of total billed charges · outpatientfrom % of charges | $50 | $50 | — | — | — | $50 – $50 |
| 8 | Medica medicare replacement facility · percent of total billed charges · outpatientfrom % of charges | $50 | $50 | — | — | — | $50 – $50 |
| 9 | Ucare medicare replacement facility · percent of total billed charges · outpatientfrom % of charges | $50 | $50 | — | — | — | $50 – $50 |
| 10 | UnitedHealthcare medicare replacement facility · percent of total billed charges · outpatientfrom % of charges | $50 | $50 | — | — | — | $50 – $50 |
| 11 | Medica pmap facility · percent of total billed charges · inpatientfrom % of charges | $57 | $57 | — | — | — | $57 – $57 |
| 12 | Medica pmap facility · percent of total billed charges · outpatientfrom % of charges | $57 | $57 | — | — | — | $57 – $57 |
| 13 | UnitedHealthcare commercial facility · percent of total billed charges · inpatientfrom % of charges | $93 | $93 | — | — | — | $93 – $93 |
| 14 | UnitedHealthcare commercial facility · percent of total billed charges · outpatientfrom % of charges | $93 | $93 | — | — | — | $93 – $93 |
| 15 | Bcbs Mn commercial facility · percent of total billed charges · outpatientfrom % of charges | $96 | $96 | — | — | — | $96 – $96 |
| 16 | Bcbs Nd commercial facility · percent of total billed charges · outpatientfrom % of charges | $96 | $96 | — | — | — | $96 – $96 |
| 17 | Blue Cross Blue Shield commercial facility · percent of total billed charges · outpatientfrom % of charges | $96 | $96 | — | — | — | $96 – $96 |
| 18 | Wellmark commercial facility · percent of total billed charges · outpatientfrom % of charges | $96 | $96 | — | — | — | $96 – $96 |
| 19 | Medica commercial facility · percent of total billed charges · inpatientfrom % of charges | $107 | $107 | — | — | — | $107 – $107 |
| 20 | Medica commercial facility · percent of total billed charges · outpatientfrom % of charges | $107 | $107 | — | — | — | $107 – $107 |
Last updated: Feb 3, 2026
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