Custom diabetic footwear insert, carved from a foot scan 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

Mult den insert dir carv/cam

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 $61 is 9% above the median hospital's median price ($56), higher than 73% of the 698 hospitals reporting HCPCS A5514. The highlighted bar is where this hospital falls; shaded is the middle 50% of hospitals.

Payers reporting HCPCS A5514 at Fairview Maple Grove Surgery Center

Negotiated rates from the hospital’s own file: 5 payers, 22 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	$46	$46	—	—	—	$46 – $46
2	Blue Cross Blue Shield commercial fee schedule · outpatient	$47	$47	—	—	—	$47 – $47
3	Blue Cross Blue Shield medicaid fee schedule · outpatient	$47	$47	—	—	—	$47 – $47
4	Blue Cross Blue Shield federal fee schedule · both	$50	$50	—	—	—	$50 – $50
5	Blue Cross Blue Shield commercial fee schedule · both	$51	$51	—	—	—	$51 – $51
6	Medica accessability fee schedule · both	$53	$53	—	—	—	$53 – $53
7	Medica medicaid fee schedule · both	$53	$53	—	—	—	$53 – $53
8	Medica ma non-snp fee schedule · both	$57	$57	—	—	—	$57 – $57
9	Medica ma snp fee schedule · both	$57	$57	—	—	—	$57 – $57
10	Medica prime solution fee schedule · both	$57	$57	—	—	—	$57 – $57
11	Medica vantage fee schedule · both	$57	$57	—	—	—	$57 – $57
12	Blue Cross Blue Shield medicaid fee schedule · both	$58	$58	—	—	—	$58 – $58
13	Ucare mhcp fee schedule · both	$59	$59	—	—	—	$59 – $59
14	Cigna commercial fee schedule · both	$71	$71	$6	9%	—	$65 – $77
15	Ucare ifp with fairview fee schedule · outpatient	$95	$95	—	—	—	$95 – $95
16	Medica bold fee schedule · both	$100	$100	—	—	—	$100 – $100
17	UnitedHealthcare commercial fee schedule · both	$104	$104	—	—	—	$104 – $104
18	Medica choice without / elect fee schedule · both	$111	$111	—	—	—	$111 – $111
19	Medica city of st paul / essential uplan fee schedule · both	$111	$111	—	—	—	$111 – $111
20	Medica choice with fee schedule · both	$114	$114	—	—	—	$114 – $114
21	Ucare ifp fee schedule · outpatient	$127	$127	—	—	—	$127 – $127
22	Cigna commercial fee schedule · outpatient	$148	$148	$13	9%	—	$136 – $161

Last updated: May 18, 2026

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