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
O shoe add felt w leath insl
Maple Grove, MN
See all hospitals reporting HCPCS L3520 →Price type
Fairview Maple Grove Surgery Center’s median price of $43 is 8% above the median hospital's median price ($40), higher than 73% of the 814 hospitals reporting HCPCS L3520. 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 | $33 | $33 | — | — | — | $33 – $33 |
| 2 | Blue Cross Blue Shield commercial fee schedule · outpatient | $33 | $33 | — | — | — | $33 – $33 |
| 3 | Blue Cross Blue Shield medicaid fee schedule · outpatient | $33 | $33 | — | — | — | $33 – $33 |
| 4 | Blue Cross Blue Shield federal fee schedule · both | $36 | $36 | — | — | — | $36 – $36 |
| 5 | Blue Cross Blue Shield commercial fee schedule · both | $36 | $36 | — | — | — | $36 – $36 |
| 6 | Medica accessability fee schedule · both | $37 | $37 | — | — | — | $37 – $37 |
| 7 | Medica medicaid fee schedule · both | $37 | $37 | — | — | — | $37 – $37 |
| 8 | Medica ma non-snp fee schedule · both | $41 | $41 | — | — | — | $41 – $41 |
| 9 | Medica ma snp fee schedule · both | $41 | $41 | — | — | — | $41 – $41 |
| 10 | Medica prime solution fee schedule · both | $41 | $41 | — | — | — | $41 – $41 |
| 11 | Medica vantage fee schedule · both | $41 | $41 | — | — | — | $41 – $41 |
| 12 | Blue Cross Blue Shield medicaid fee schedule · both | $41 | $41 | — | — | — | $41 – $41 |
| 13 | Ucare mhcp fee schedule · both | $42 | $42 | — | — | — | $42 – $42 |
| 14 | Cigna commercial fee schedule · both | $50 | $50 | $4 | 9% | — | $46 – $54 |
| 15 | Ucare ifp with fairview fee schedule · outpatient | $67 | $67 | — | — | — | $67 – $67 |
| 16 | Medica bold fee schedule · both | $71 | $71 | — | — | — | $71 – $71 |
| 17 | UnitedHealthcare commercial fee schedule · both | $73 | $73 | — | — | — | $73 – $73 |
| 18 | Medica choice without / elect fee schedule · both | $78 | $78 | — | — | — | $78 – $78 |
| 19 | Medica city of st paul / essential uplan fee schedule · both | $78 | $78 | — | — | — | $78 – $78 |
| 20 | Medica choice with fee schedule · both | $81 | $81 | — | — | — | $81 – $81 |
| 21 | Ucare ifp fee schedule · outpatient | $90 | $90 | — | — | — | $90 – $90 |
| 22 | Cigna commercial fee schedule · outpatient | $105 | $105 | $9 | 9% | — | $96 – $114 |
Last updated: May 18, 2026
See Felt-covered leather orthopedic shoe insole pricing across every hospital in the network reporting it, or ask Claude or any MCP client directly — see how to connect.