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
LSH W/T/O UT 250 G OR LESS
Maple Grove, MN
See all hospitals reporting CPT 58542 →Price type
Fairview Maple Grove Surgery Center’s median price of $3.1k is 70% below the median hospital's median price ($10.4k), higher than 20% of the 1,776 hospitals reporting CPT 58542. 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, 41 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 | Medicaid medicaid fee schedule · both | $554 | $554 | — | — | — | $554 – $554 |
| 2 | Ucare mhcp fee schedule · both | $565 | $565 | — | — | — | $565 – $565 |
| 3 | Medica accessability fee schedule · both | $596 | $596 | — | — | — | $596 – $596 |
| 4 | Medica medicaid fee schedule · both | $596 | $596 | — | — | — | $596 – $596 |
| 5 | Blue Cross Blue Shield medicaid fee schedule · both | $638 | $638 | — | — | — | $638 – $638 |
| 6 | UnitedHealthcare medicare advantage fee schedule · both | $751 | $751 | — | — | — | $751 – $751 |
| 7 | Blue Cross Blue Shield medicare advantage fee schedule · both | $781 | $781 | — | — | — | $781 – $781 |
| 8 | Medica ma non-snp fee schedule · both | $807 | $807 | — | — | — | $807 – $807 |
| 9 | Medica ma snp fee schedule · both | $807 | $807 | — | — | — | $807 – $807 |
| 10 | Medica prime solution fee schedule · both | $807 | $807 | — | — | — | $807 – $807 |
| 11 | Medica vantage fee schedule · both | $807 | $807 | — | — | — | $807 – $807 |
| 12 | Medica accessability fee schedule · outpatient | $1.7k | $1.7k | — | — | — | $1.7k – $1.7k |
| 13 | Medica medicaid fee schedule · outpatient | $2.0k | $2.0k | — | — | — | $2.0k – $2.0k |
| 14 | Ucare ifp with fairview fee schedule · both | $2.0k | $2.0k | — | — | — | $2.0k – $2.0k |
| 15 | Ucare ifp fee schedule · both | $2.1k | $2.1k | — | — | — | $2.1k – $2.1k |
| 16 | Medica bold fee schedule · both | $2.4k | $2.4k | — | — | — | $2.4k – $2.4k |
| 17 | Medica ma snp fee schedule · outpatient | $2.6k | $2.6k | — | — | — | $2.6k – $2.6k |
| 18 | Medica choice without / elect fee schedule · both | $2.7k | $2.7k | — | — | — | $2.7k – $2.7k |
| 19 | Medica city of st paul / essential uplan fee schedule · both | $2.7k | $2.7k | — | — | — | $2.7k – $2.7k |
| 20 | UnitedHealthcare commercial fee schedule · both | $2.7k | $2.7k | — | — | — | $2.7k – $2.7k |
| 21 | Medica choice with fee schedule · both | $2.7k | $2.7k | — | — | — | $2.7k – $2.7k |
| 22 | Blue Cross Blue Shield federal fee schedule · both | $2.8k | $2.8k | — | — | — | $2.8k – $2.8k |
| 23 | Blue Cross Blue Shield commercial fee schedule · both | $2.8k | $2.8k | — | — | — | $2.8k – $2.8k |
| 24 | Cigna commercial fee schedule · both | $3.6k | $3.6k | $312 | 9% | — | $3.3k – $3.9k |
| 25 | Blue Cross Blue Shield medicaid fee schedule · outpatient | $4.0k | $4.0k | — | — | — | $4.0k – $4.0k |
Last updated: May 18, 2026
See Laparoscopic hysterectomy with removal of tubes and/or ovaries pricing across every hospital in the network reporting it, or ask Claude or any MCP client directly — see how to connect.