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HANK Price Transparency. (n.d.).
GRAFT SOFT TISSUE 5X5CM MATRISTEM BURN MATRIX (CPT Q4120) by State .
PPMan price-transparency data, derived from CMS-required hospital MRFs.
Retrieved June 30, 2026 , from http://ppman.hank.ai/transparency/procedure/Q4120/by-state?code_type=CPT
“GRAFT SOFT TISSUE 5X5CM MATRISTEM BURN MATRIX (CPT Q4120) by State.” HANK Price Transparency ,
http://ppman.hank.ai/transparency/procedure/Q4120/by-state?code_type=CPT. Accessed
June 30, 2026 .
“GRAFT SOFT TISSUE 5X5CM MATRISTEM BURN MATRIX (CPT Q4120) by State,” HANK Price Transparency ,
accessed June 30, 2026 ,
http://ppman.hank.ai/transparency/procedure/Q4120/by-state?code_type=CPT.
Source: PPMan price-transparency data, derived from CMS-required hospital
machine-readable files (45 CFR 180). See
methodology .
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CPT · across United States
Q4120 — Graft Soft Tissue 5x5cm Matristem Burn Matrix
State-by-state median negotiated rates. Lower bars are cheaper states; the
range bar shows the IQR (25th to 75th percentile within each state).
$35
National median
$18 – $1,551
IQR (p25 – p75)
29
hospitals filing
11
states
Walking in without insurance?
Cash / self-pay price
Cash median
$1,275
vs. negotiated
+3548.1%
Hospitals reporting
6
Cash / self-pay rates apply when you don't run the bill through insurance.
Many hospitals also offer income-based discounts on top of the published
cash price — always ask about a financial-assistance application
before paying.
Median negotiated rate, by state
Ranked by typical (median) negotiated price. Hover for state-level IQR.
Median negotiated rate by state for Q4120 (CPT), with interquartile range
State Median p25 p75
GA $4,562 $4,156 $7,937
TX $4,399 $1,976 $5,419
SD $1,725 $1,725 $1,725
OH $1,064 $798 $1,138
NE $1,059 $1,059 $1,059
MN $715 $576 $854
FL $127 $73 $127
WV $95 $95 $95
PA $50 $50 $50
SC $34 $33 $35
NJ $21 $15 $34