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
INSJ/RPLC CAR MODULJ PLS GN
Wyoming, MN
See all hospitals reporting CPT 0409T →Price type
Fairview Health Services’s median price of $17.1k is 24% below the median hospital's median price ($22.5k), higher than 24% of the 1,319 hospitals reporting CPT 0409T. The highlighted bar is where this hospital falls; shaded is the middle 50% of hospitals.
Negotiated rates from the hospital’s own file: 6 payers, 26 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 | Medica medicare advantage non-snp fee schedule · both | $356.31 | $356.31 | $356.31 – $356.31 |
| 2 | Medica msho/medicare advantage snp fee schedule · both | $363.03 | $363.03 | $363.03 – $363.03 |
| 3 | Medica bold fee schedule · both | $642.56 | $642.56 | $642.56 – $642.56 |
| 4 | Medica vantage self insured fee schedule · both | $696.11 | $696.11 | $696.11 – $696.11 |
| 5 | Medica city of st. paul/essential fee schedule · both | $713.96 | $713.96 | $713.96 – $713.96 |
| 6 | Medica individual and family business (except aco) and elect fee schedule · both | $713.96 | $713.96 | $713.96 – $713.96 |
| 7 | Medica choice fee schedule · both | $738.83 | $738.83 | $738.83 – $738.83 |
| 8 | UnitedHealthcare commercial fee schedule · both | $1,094 | $1,094 | $1,094 – $1,094 |
| 9 | UnitedHealthcare core fee schedule · both | $1,094 | $1,094 | $1,094 – $1,094 |
| 10 | Medica managed medicaid/accessability case rate · outpatient | $4,489 | $4,489 | $4,489 – $4,489 |
| 11 | Medica msho/medicare advantage snp case rate · outpatient | $6,960 | $6,960 | $6,960 – $6,960 |
| 12 | Medica bold case rate · outpatient | $12,845 | $12,845 | $12,845 – $12,845 |
| 13 | Medica city of st. paul/essential case rate · outpatient | $13,295 | $13,295 | $13,295 – $13,295 |
| 14 | UnitedHealthcare core case rate · outpatient | $13,673 | $13,673 | $13,673 – $13,673 |
| 15 | Medica vantage self insured case rate · outpatient | $13,916 | $13,916 | $13,916 – $13,916 |
| 16 | Medica individual and family business (except aco) and elect case rate · outpatient | $14,273 | $14,273 | $14,273 – $14,273 |
| 17 | Medica choice case rate · outpatient | $14,772 | $14,772 | $14,772 – $14,772 |
| 18 | UnitedHealthcare commercial case rate · outpatient | $15,133 | $15,133 | $15,133 – $15,133 |
| 19 | Sanford Health Plan medicare advantage fee schedule · outpatient | $22,343 | $22,343 | $22,343 – $22,343 |
| 20 | UnitedHealthcare medicare advantage fee schedule · outpatient | $22,343 | $22,343 | $22,343 – $22,343 |
| 21 | WellCare medicare advantage fee schedule · outpatient | $22,343 | $22,343 | $22,343 – $22,343 |
| 22 | Ucare medicare advantage/msho fee schedule · outpatient | $22,678 | $22,678 | $22,678 – $22,678 |
| 23 | Bcbs Mn medicare advantage fee schedule · outpatient | $23,237 | $23,237 | $23,237 – $23,237 |
| 24 | Medica medicare advantage non-snp fee schedule · outpatient | $23,683 | $23,683 | $23,683 – $23,683 |
| 25 | Ucare individual and family with m health fairview fee schedule · outpatient | $39,726 | $39,726 | $39,726 – $39,726 |
Last updated: Feb 5, 2026
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