Glatiramer acetate injection, 20 mg 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
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Reasoning effort: low
Max output tokens: 4096
Prompt version (hash): 444523875572
Generated: October 20, 2026

Original text from hospital filings

GLATIRAMER ACETATE 40 MG/ML SC SOSY

Maple Grove, MN

See all hospitals reporting HCPCS J1595 →

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How this price compares nationally

Fairview Maple Grove Surgery Center’s median price of $159 is 22% below the median hospital's median price ($204), higher than 22% of the 1,390 hospitals reporting HCPCS J1595. The highlighted bar is where this hospital falls; shaded is the middle 50% of hospitals.

Payers reporting HCPCS J1595 at Fairview Maple Grove Surgery Center

Negotiated rates from the hospital’s own file: 8 payers, 29 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 ma non-snp fee schedule · both	$61	$61	—	—	—	$61 – $61
2	Medica ma snp fee schedule · both	$61	$61	—	—	—	$61 – $61
3	Medica prime solution fee schedule · both	$61	$61	—	—	—	$61 – $61
4	Medica vantage fee schedule · both	$61	$61	—	—	—	$61 – $61
5	Ucare mhcp fee schedule · both	$65	$65	—	—	—	$65 – $65
6	Ucare ifp with fairview fee schedule · both	$65	$65	—	—	—	$65 – $65
7	Medica accessability fee schedule · both	$68	$68	—	—	—	$68 – $68
8	Medica medicaid fee schedule · both	$68	$68	—	—	—	$68 – $68
9	Ucare ifp fee schedule · both	$69	$69	—	—	—	$69 – $69
10	Medicaid medicaid fee schedule · both	$72	$72	—	—	—	$72 – $72
11	Blue Cross Blue Shield medicaid fee schedule · both	$74	$74	—	—	—	$74 – $74
12	Cigna commercial fee schedule · both	$83	$83	$7	9%	—	$75 – $90
13	UnitedHealthcare commercial fee schedule · both	$104	$104	—	—	—	$104 – $104
14	Medica bold fee schedule · both	$108	$108	—	—	—	$108 – $108
15	Medica choice without / elect fee schedule · both	$120	$120	—	—	—	$120 – $120
16	Medica city of st paul / essential uplan fee schedule · both	$120	$120	—	—	—	$120 – $120
17	Medica choice with fee schedule · both	$125	$125	—	—	—	$125 – $125
18	Cigna commercial fee schedule · outpatient	$127	$127	$11	9%	—	$116 – $138
19	UnitedHealthcare medicare advantage fee schedule · outpatient	$165	$165	—	—	—	$165 – $165
20	Blue Cross Blue Shield medicare advantage fee schedule · outpatient	$171	$171	—	—	—	$171 – $171
21	Blue Cross Blue Shield federal fee schedule · both	$184	$184	—	—	—	$184 – $184
22	Blue Cross Blue Shield federal fee schedule · outpatient	$184	$184	—	—	—	$184 – $184
23	Blue Cross Blue Shield commercial fee schedule · both	$187	$187	—	—	—	$187 – $187
24	Blue Cross Blue Shield commercial fee schedule · outpatient	$187	$187	—	—	—	$187 – $187
25	Blue Cross Blue Shield medicaid fee schedule · outpatient	$187	$187	—	—	—	$187 – $187

Page 1 of 2 · 29 rates

Last updated: May 18, 2026

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