Infant high-top orthopedic shoes with arch support 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-sonnet-5-5
Provider: anthropic
API: message_batches
Reasoning effort: model default
Max output tokens: 4096
Prompt version (hash): 444523875572
Generated: October 20, 2026

Original text from hospital filings

Hightop w/ supp/pronator inf

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 $57 is 9% above the median hospital's median price ($53), higher than 55% of the 327 hospitals reporting HCPCS L3204. The highlighted bar is where this hospital falls; shaded is the middle 50% of hospitals.

Payers reporting HCPCS L3204 at Fairview Maple Grove Surgery Center

Negotiated rates from the hospital’s own file: 4 payers, 16 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	$36	$36	—	—	—	$36 – $36
2	Medica ma snp fee schedule · both	$36	$36	—	—	—	$36 – $36
3	Medica prime solution fee schedule · both	$36	$36	—	—	—	$36 – $36
4	Medica vantage fee schedule · both	$36	$36	—	—	—	$36 – $36
5	Cigna commercial fee schedule · both	$45	$45	$4	9%	—	$41 – $49
6	Blue Cross Blue Shield federal fee schedule · both	$56	$56	—	—	—	$56 – $56
7	Blue Cross Blue Shield federal fee schedule · outpatient	$56	$56	—	—	—	$56 – $56
8	Blue Cross Blue Shield commercial fee schedule · both	$57	$57	—	—	—	$57 – $57
9	Blue Cross Blue Shield commercial fee schedule · outpatient	$57	$57	—	—	—	$57 – $57
10	Blue Cross Blue Shield medicaid fee schedule · outpatient	$57	$57	—	—	—	$57 – $57
11	Medica bold fee schedule · both	$64	$64	—	—	—	$64 – $64
12	Medica choice without / elect fee schedule · both	$71	$71	—	—	—	$71 – $71
13	Medica city of st paul / essential uplan fee schedule · both	$71	$71	—	—	—	$71 – $71
14	Medica choice with fee schedule · both	$74	$74	—	—	—	$74 – $74
15	UnitedHealthcare commercial fee schedule · both	$94	$94	—	—	—	$94 – $94
16	Cigna commercial fee schedule · outpatient	$94	$94	$8	9%	—	$86 – $102

Last updated: May 18, 2026

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See Infant high-top orthopedic shoes with arch support pricing across every hospital in the network reporting it, or ask Claude or any MCP client directly — see how to connect.