Urinary ostomy pouch with attached rubber faceplate at Fairview Maple Grove Surgery Center

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.

Model: claude-haiku-5-5
Provider: anthropic
API: message_batches
Reasoning effort: low
Max output tokens: 4096
Prompt version (hash): 444523875572
Generated: October 20, 2026

Original text from hospital filings

Urinary rubber pouch w fcplt

Maple Grove, MN

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Pricing by billing methodology

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How this price compares nationally

Fairview Maple Grove Surgery Center’s median price of $56 is 4% above the median hospital's median price ($54), higher than 67% of the 666 hospitals reporting HCPCS A4380. The highlighted bar is where this hospital falls; shaded is the middle 50% of hospitals.

Payers reporting HCPCS A4380 at Fairview Maple Grove Surgery Center

Negotiated rates from the hospital’s own file: 5 payers, 21 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 federal fee schedule · outpatient	$45	$45	—	—	—	$45 – $45
2	Blue Cross Blue Shield commercial fee schedule · outpatient	$45	$45	—	—	—	$45 – $45
3	Blue Cross Blue Shield medicaid fee schedule · outpatient	$45	$45	—	—	—	$45 – $45
4	Blue Cross Blue Shield federal fee schedule · both	$48	$48	—	—	—	$48 – $48
5	Blue Cross Blue Shield commercial fee schedule · both	$49	$49	—	—	—	$49 – $49
6	Medica accessability fee schedule · both	$51	$51	—	—	—	$51 – $51
7	Medica medicaid fee schedule · both	$51	$51	—	—	—	$51 – $51
8	Medica ma non-snp fee schedule · both	$55	$55	—	—	—	$55 – $55
9	Medica ma snp fee schedule · both	$55	$55	—	—	—	$55 – $55
10	Medica prime solution fee schedule · both	$55	$55	—	—	—	$55 – $55
11	Medica vantage fee schedule · both	$55	$55	—	—	—	$55 – $55
12	Blue Cross Blue Shield medicaid fee schedule · both	$55	$55	—	—	—	$55 – $55
13	Ucare mhcp fee schedule · both	$57	$57	—	—	—	$57 – $57
14	Cigna commercial fee schedule · both	$68	$68	$6	9%	—	$63 – $74
15	Ucare ifp with fairview fee schedule · outpatient	$92	$92	—	—	—	$92 – $92
16	UnitedHealthcare commercial fee schedule · both	$95	$95	—	—	—	$95 – $95
17	Medica bold fee schedule · both	$96	$96	—	—	—	$96 – $96
18	Medica choice without / elect fee schedule · both	$107	$107	—	—	—	$107 – $107
19	Medica city of st paul / essential uplan fee schedule · both	$107	$107	—	—	—	$107 – $107
20	Medica choice with fee schedule · both	$110	$110	—	—	—	$110 – $110
21	Ucare ifp fee schedule · outpatient	$122	$122	—	—	—	$122 – $122

Last updated: May 18, 2026

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