Spinal brace with rigid plastic shells 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 2 piece rigid shell

Maple Grove, MN

See all hospitals reporting HCPCS L0491 →

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Pricing by billing methodology

Price type

How this price compares nationally

Fairview Maple Grove Surgery Center’s median price of $1.0k is 8% above the median hospital's median price ($968), higher than 73% of the 858 hospitals reporting HCPCS L0491. The highlighted bar is where this hospital falls; shaded is the middle 50% of hospitals.

Payers reporting HCPCS L0491 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	Blue Cross Blue Shield federal fee schedule · outpatient	$793	$793	—	—	—	$793 – $793
2	Blue Cross Blue Shield commercial fee schedule · outpatient	$807	$807	—	—	—	$807 – $807
3	Blue Cross Blue Shield medicaid fee schedule · outpatient	$807	$807	—	—	—	$807 – $807
4	Blue Cross Blue Shield federal fee schedule · both	$858	$858	—	—	—	$858 – $858
5	Blue Cross Blue Shield commercial fee schedule · both	$874	$874	—	—	—	$874 – $874
6	Medica accessability fee schedule · both	$904	$904	—	—	—	$904 – $904
7	Medica medicaid fee schedule · both	$904	$904	—	—	—	$904 – $904
8	Medica ma non-snp fee schedule · both	$981	$981	—	—	—	$981 – $981
9	Medica ma snp fee schedule · both	$981	$981	—	—	—	$981 – $981
10	Medica prime solution fee schedule · both	$981	$981	—	—	—	$981 – $981
11	Medica vantage fee schedule · both	$981	$981	—	—	—	$981 – $981
12	Blue Cross Blue Shield medicaid fee schedule · both	$984	$984	—	—	—	$984 – $984
13	Ucare mhcp fee schedule · both	$1.0k	$1.0k	—	—	—	$1.0k – $1.0k
14	Cigna commercial fee schedule · both	$1.2k	$1.2k	$105	9%	—	$1.1k – $1.3k
15	Ucare ifp with fairview fee schedule · outpatient	$1.6k	$1.6k	—	—	—	$1.6k – $1.6k
16	Medica bold fee schedule · both	$1.7k	$1.7k	—	—	—	$1.7k – $1.7k
17	UnitedHealthcare commercial fee schedule · both	$1.8k	$1.8k	—	—	—	$1.8k – $1.8k
18	Medica choice without / elect fee schedule · both	$1.9k	$1.9k	—	—	—	$1.9k – $1.9k
19	Medica city of st paul / essential uplan fee schedule · both	$1.9k	$1.9k	—	—	—	$1.9k – $1.9k
20	Medica choice with fee schedule · both	$2.0k	$2.0k	—	—	—	$2.0k – $2.0k
21	Ucare ifp fee schedule · outpatient	$2.2k	$2.2k	—	—	—	$2.2k – $2.2k
22	Cigna commercial fee schedule · outpatient	$2.5k	$2.5k	$221	9%	—	$2.3k – $2.8k

Last updated: May 18, 2026

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