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
Tlso trnk sj-t9 pre cst
Maple Grove, MN
See all hospitals reporting HCPCS L0454 →Price type
Fairview Maple Grove Surgery Center’s median price of $467 is 7% above the median hospital's median price ($437), higher than 72% of the 849 hospitals reporting HCPCS L0454. 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 | Blue Cross Blue Shield federal fee schedule · outpatient | $358 | $358 | — | — | — | $358 – $358 |
| 2 | Blue Cross Blue Shield commercial fee schedule · outpatient | $364 | $364 | — | — | — | $364 – $364 |
| 3 | Blue Cross Blue Shield medicaid fee schedule · outpatient | $364 | $364 | — | — | — | $364 – $364 |
| 4 | Blue Cross Blue Shield federal fee schedule · both | $388 | $388 | — | — | — | $388 – $388 |
| 5 | Blue Cross Blue Shield commercial fee schedule · both | $395 | $395 | — | — | — | $395 – $395 |
| 6 | Medica accessability fee schedule · both | $408 | $408 | — | — | — | $408 – $408 |
| 7 | Medica medicaid fee schedule · both | $408 | $408 | — | — | — | $408 – $408 |
| 8 | Medica ma non-snp fee schedule · both | $443 | $443 | — | — | — | $443 – $443 |
| 9 | Medica ma snp fee schedule · both | $443 | $443 | — | — | — | $443 – $443 |
| 10 | Medica prime solution fee schedule · both | $443 | $443 | — | — | — | $443 – $443 |
| 11 | Medica vantage fee schedule · both | $443 | $443 | — | — | — | $443 – $443 |
| 12 | Blue Cross Blue Shield medicaid fee schedule · both | $445 | $445 | — | — | — | $445 – $445 |
| 13 | Ucare mhcp fee schedule · both | $455 | $455 | — | — | — | $455 – $455 |
| 14 | Cigna commercial fee schedule · both | $547 | $547 | $48 | 9% | — | $499 – $595 |
| 15 | Ucare ifp with fairview fee schedule · outpatient | $735 | $735 | — | — | — | $735 – $735 |
| 16 | Medica bold fee schedule · both | $769 | $769 | — | — | — | $769 – $769 |
| 17 | UnitedHealthcare commercial fee schedule · both | $799 | $799 | — | — | — | $799 – $799 |
| 18 | Medica choice without / elect fee schedule · both | $855 | $855 | — | — | — | $855 – $855 |
| 19 | Medica city of st paul / essential uplan fee schedule · both | $855 | $855 | — | — | — | $855 – $855 |
| 20 | Medica choice with fee schedule · both | $885 | $885 | — | — | — | $885 – $885 |
| 21 | Ucare ifp fee schedule · outpatient | $979 | $979 | — | — | — | $979 – $979 |
| 22 | Cigna commercial fee schedule · outpatient | $1.1k | $1.1k | $100 | 9% | — | $1.0k – $1.2k |
Last updated: May 18, 2026
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