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
PWC gp 3 xhd seat/back
Maple Grove, MN
See all hospitals reporting HCPCS K0854 →Price type
Fairview Maple Grove Surgery Center’s median price of $3.6k is 91% above the median hospital's median price ($1.9k), higher than 65% of the 570 hospitals reporting HCPCS K0854. The highlighted bar is where this hospital falls; shaded is the middle 50% of hospitals.
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 | Medica ma non-snp fee schedule · both | $1.8k | $1.8k | — | — | — | $1.8k – $1.8k |
| 2 | Medica ma snp fee schedule · both | $1.8k | $1.8k | — | — | — | $1.8k – $1.8k |
| 3 | Medica prime solution fee schedule · both | $1.8k | $1.8k | — | — | — | $1.8k – $1.8k |
| 4 | Medica vantage fee schedule · both | $1.8k | $1.8k | — | — | — | $1.8k – $1.8k |
| 5 | Ucare ifp with fairview fee schedule · outpatient | $3.1k | $3.1k | — | — | — | $3.1k – $3.1k |
| 6 | Medica bold fee schedule · both | $3.2k | $3.2k | — | — | — | $3.2k – $3.2k |
| 7 | Medica choice without / elect fee schedule · both | $3.6k | $3.6k | — | — | — | $3.6k – $3.6k |
| 8 | Medica city of st paul / essential uplan fee schedule · both | $3.6k | $3.6k | — | — | — | $3.6k – $3.6k |
| 9 | Medica choice with fee schedule · both | $3.7k | $3.7k | — | — | — | $3.7k – $3.7k |
| 10 | Ucare ifp fee schedule · outpatient | $4.1k | $4.1k | — | — | — | $4.1k – $4.1k |
| 11 | Blue Cross Blue Shield medicaid fee schedule · both | $7.1k | $7.1k | $5.2k | 74% | — | $1.9k – $12.3k |
| 12 | Ucare mhcp fee schedule · both | $7.3k | $7.3k | $5.4k | 74% | — | $1.9k – $12.6k |
| 13 | Blue Cross Blue Shield commercial fee schedule · both | $9.3k | $9.3k | $7.6k | 82% | — | $1.7k – $17.0k |
| 14 | Blue Cross Blue Shield federal fee schedule · both | $9.3k | $9.3k | $7.6k | 82% | — | $1.7k – $17.0k |
| 15 | Medica accessability fee schedule · both | $11.3k | $11.3k | — | — | — | $11.3k – $11.3k |
| 16 | Medica medicaid fee schedule · both | $11.3k | $11.3k | — | — | — | $11.3k – $11.3k |
| 17 | Cigna commercial fee schedule · both | $11.6k | $12.5k | $10.4k | 83% | — | $2.1k – $24.8k |
| 18 | UnitedHealthcare commercial fee schedule · both | $21.1k | $15.1k | $8.5k | 56% | — | $3.2k – $21.1k |
| 19 | Blue Cross Blue Shield federal fee schedule · outpatient | $15.7k | $15.7k | — | — | — | $15.7k – $15.7k |
| 20 | Blue Cross Blue Shield commercial fee schedule · outpatient | $15.9k | $15.9k | — | — | — | $15.9k – $15.9k |
| 21 | Blue Cross Blue Shield medicaid fee schedule · outpatient | $15.9k | $15.9k | — | — | — | $15.9k – $15.9k |
| 22 | Cigna commercial fee schedule · outpatient | $47.9k | $47.9k | $4.2k | 9% | — | $43.7k – $52.0k |
Last updated: May 18, 2026
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