Sacroiliac support brace with rigid panels 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

Sio rig pnl pelv/sac pre ots

Maple Grove, MN

See all hospitals reporting HCPCS L0623 →

SharePost on X LinkedIn

Pricing by billing methodology

Price type

How this price compares nationally

Fairview Maple Grove Surgery Center’s median price of $154 is 13% above the median hospital's median price ($136), higher than 72% of the 831 hospitals reporting HCPCS L0623. The highlighted bar is where this hospital falls; shaded is the middle 50% of hospitals.

Payers reporting HCPCS L0623 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.

Filter by billing methodology

Filter by billing class

#
1	Medica accessability fee schedule · both	$127	$127	—	—	—	$127 – $127
2	Medica medicaid fee schedule · both	$127	$127	—	—	—	$127 – $127
3	Blue Cross Blue Shield medicaid fee schedule · both	$138	$138	—	—	—	$138 – $138
4	Medica ma non-snp fee schedule · both	$139	$139	—	—	—	$139 – $139
5	Medica ma snp fee schedule · both	$139	$139	—	—	—	$139 – $139
6	Medica prime solution fee schedule · both	$139	$139	—	—	—	$139 – $139
7	Medica vantage fee schedule · both	$139	$139	—	—	—	$139 – $139
8	Ucare mhcp fee schedule · both	$143	$143	—	—	—	$143 – $143
9	Blue Cross Blue Shield federal fee schedule · outpatient	$150	$150	—	—	—	$150 – $150
10	Blue Cross Blue Shield commercial fee schedule · outpatient	$152	$152	—	—	—	$152 – $152
11	Blue Cross Blue Shield medicaid fee schedule · outpatient	$152	$152	—	—	—	$152 – $152
12	Blue Cross Blue Shield federal fee schedule · both	$160	$160	—	—	—	$160 – $160
13	Blue Cross Blue Shield commercial fee schedule · both	$163	$163	—	—	—	$163 – $163
14	Cigna commercial fee schedule · both	$170	$170	$15	9%	—	$156 – $185
15	Ucare ifp with fairview fee schedule · outpatient	$232	$232	—	—	—	$232 – $232
16	Medica bold fee schedule · both	$240	$240	—	—	—	$240 – $240
17	Medica choice without / elect fee schedule · both	$266	$266	—	—	—	$266 – $266
18	Medica city of st paul / essential uplan fee schedule · both	$266	$266	—	—	—	$266 – $266
19	Medica choice with fee schedule · both	$276	$276	—	—	—	$276 – $276
20	Ucare ifp fee schedule · outpatient	$309	$309	—	—	—	$309 – $309
21	Cigna commercial fee schedule · outpatient	$358	$358	$31	9%	—	$327 – $389
22	UnitedHealthcare commercial fee schedule · both	$408	$408	—	—	—	$408 – $408

Last updated: May 18, 2026

Compare to other hospitals

See Sacroiliac support brace with rigid panels pricing across every hospital in the network reporting it, or ask Claude or any MCP client directly — see how to connect.