Thoracolumbosacral orthosis, flexible back brace 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

Tlso flex trnk sj-t9 pre ots

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 $302 is 12% above the median hospital's median price ($270), higher than 69% of the 833 hospitals reporting HCPCS L0455. The highlighted bar is where this hospital falls; shaded is the middle 50% of hospitals.

Payers reporting HCPCS L0455 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	Medica accessability fee schedule · both	$250	$250	—	—	—	$250 – $250
2	Medica medicaid fee schedule · both	$250	$250	—	—	—	$250 – $250
3	Blue Cross Blue Shield medicaid fee schedule · both	$272	$272	—	—	—	$272 – $272
4	Medica ma non-snp fee schedule · both	$273	$273	—	—	—	$273 – $273
5	Medica ma snp fee schedule · both	$273	$273	—	—	—	$273 – $273
6	Medica prime solution fee schedule · both	$273	$273	—	—	—	$273 – $273
7	Medica vantage fee schedule · both	$273	$273	—	—	—	$273 – $273
8	Ucare mhcp fee schedule · both	$280	$280	—	—	—	$280 – $280
9	Blue Cross Blue Shield federal fee schedule · outpatient	$294	$294	—	—	—	$294 – $294
10	Blue Cross Blue Shield commercial fee schedule · outpatient	$299	$299	—	—	—	$299 – $299
11	Blue Cross Blue Shield medicaid fee schedule · outpatient	$299	$299	—	—	—	$299 – $299
12	Blue Cross Blue Shield federal fee schedule · both	$315	$315	—	—	—	$315 – $315
13	Blue Cross Blue Shield commercial fee schedule · both	$320	$320	—	—	—	$320 – $320
14	Cigna commercial fee schedule · both	$335	$335	$29	9%	—	$305 – $364
15	Ucare ifp with fairview fee schedule · outpatient	$455	$455	—	—	—	$455 – $455
16	Medica bold fee schedule · both	$471	$471	—	—	—	$471 – $471
17	Medica choice without / elect fee schedule · both	$523	$523	—	—	—	$523 – $523
18	Medica city of st paul / essential uplan fee schedule · both	$523	$523	—	—	—	$523 – $523
19	Medica choice with fee schedule · both	$541	$541	—	—	—	$541 – $541
20	Ucare ifp fee schedule · outpatient	$607	$607	—	—	—	$607 – $607
21	Cigna commercial fee schedule · outpatient	$703	$703	$61	9%	—	$641 – $764
22	UnitedHealthcare commercial fee schedule · both	$799	$799	—	—	—	$799 – $799

Last updated: May 18, 2026

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