Dextran 40 infusion, 500 mL 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

DEXTRAN 40 IN SALINE 10-0.9 % IV SOLN

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 $41 is 58% below the median hospital's median price ($99), higher than 15% of the 1,385 hospitals reporting HCPCS J7100. The highlighted bar is where this hospital falls; shaded is the middle 50% of hospitals.

Payers reporting HCPCS J7100 at Fairview Maple Grove Surgery Center

Negotiated rates from the hospital’s own file: 8 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	Ucare mhcp fee schedule · both	$17	$17	—	—	—	$17 – $17
2	Ucare ifp with fairview fee schedule · both	$17	$17	—	—	—	$17 – $17
3	Medica accessability fee schedule · both	$18	$18	—	—	—	$18 – $18
4	Medica medicaid fee schedule · both	$18	$18	—	—	—	$18 – $18
5	Ucare ifp fee schedule · both	$18	$18	—	—	—	$18 – $18
6	Medicaid medicaid fee schedule · both	$19	$19	—	—	—	$19 – $19
7	Blue Cross Blue Shield medicaid fee schedule · both	$19	$19	—	—	—	$19 – $19
8	Cigna commercial fee schedule · both	$24	$24	$2	9%	—	$22 – $26
9	Blue Cross Blue Shield federal fee schedule · outpatient	$33	$33	—	—	—	$33 – $33
10	Blue Cross Blue Shield commercial fee schedule · outpatient	$34	$34	—	—	—	$34 – $34
11	Blue Cross Blue Shield medicaid fee schedule · outpatient	$34	$34	—	—	—	$34 – $34
12	Blue Cross Blue Shield federal fee schedule · both	$40	$40	—	—	—	$40 – $40
13	Blue Cross Blue Shield commercial fee schedule · both	$41	$41	—	—	—	$41 – $41
14	Medica ma non-snp fee schedule · both	$41	$41	—	—	—	$41 – $41
15	Medica ma snp fee schedule · both	$41	$41	—	—	—	$41 – $41
16	Medica prime solution fee schedule · both	$41	$41	—	—	—	$41 – $41
17	Medica vantage fee schedule · both	$41	$41	—	—	—	$41 – $41
18	Medica bold fee schedule · both	$67	$67	—	—	—	$67 – $67
19	UnitedHealthcare commercial fee schedule · both	$71	$71	—	—	—	$71 – $71
20	Medica choice without / elect fee schedule · both	$74	$74	—	—	—	$74 – $74
21	Medica city of st paul / essential uplan fee schedule · both	$74	$74	—	—	—	$74 – $74
22	Medica choice with fee schedule · both	$77	$77	—	—	—	$77 – $77
23	Ucare ifp percent of total billed charges · outpatientfrom % of charges	$100	$100	$6	6%	—	$94 – $106
24	Ucare ifp with fairview percent of total billed charges · outpatientfrom % of charges	$100	$100	$6	6%	—	$94 – $106
25	First Health commercial percent of total billed charges · outpatientfrom % of charges	$163	$163	$10	6%	—	$154 – $173

Page 1 of 2 · 26 rates

Last updated: May 18, 2026

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