Custom elbow, wrist and hand brace with adjustable joints 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

EWHO w/joint(s) CF

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 $969 is 5% above the median hospital's median price ($920), higher than 58% of the 1,050 hospitals reporting HCPCS L3764. The highlighted bar is where this hospital falls; shaded is the middle 50% of hospitals.

Payers reporting HCPCS L3764 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	$736	$736	—	—	—	$736 – $736
2	Blue Cross Blue Shield commercial fee schedule · outpatient	$749	$749	—	—	—	$749 – $749
3	Blue Cross Blue Shield medicaid fee schedule · outpatient	$749	$749	—	—	—	$749 – $749
4	Blue Cross Blue Shield federal fee schedule · both	$797	$797	—	—	—	$797 – $797
5	Blue Cross Blue Shield commercial fee schedule · both	$811	$811	—	—	—	$811 – $811
6	Medica accessability fee schedule · both	$839	$839	—	—	—	$839 – $839
7	Medica medicaid fee schedule · both	$839	$839	—	—	—	$839 – $839
8	Medica ma non-snp fee schedule · both	$910	$910	—	—	—	$910 – $910
9	Medica ma snp fee schedule · both	$910	$910	—	—	—	$910 – $910
10	Medica prime solution fee schedule · both	$910	$910	—	—	—	$910 – $910
11	Medica vantage fee schedule · both	$910	$910	—	—	—	$910 – $910
12	Blue Cross Blue Shield medicaid fee schedule · both	$913	$913	—	—	—	$913 – $913
13	Ucare mhcp fee schedule · both	$935	$935	—	—	—	$935 – $935
14	Cigna commercial fee schedule · both	$1.1k	$1.1k	$98	9%	—	$1.0k – $1.2k
15	Ucare ifp with fairview fee schedule · outpatient	$1.5k	$1.5k	—	—	—	$1.5k – $1.5k
16	Medica bold fee schedule · both	$1.6k	$1.6k	—	—	—	$1.6k – $1.6k
17	UnitedHealthcare commercial fee schedule · both	$1.7k	$1.7k	—	—	—	$1.7k – $1.7k
18	Medica choice without / elect fee schedule · both	$1.8k	$1.8k	—	—	—	$1.8k – $1.8k
19	Medica city of st paul / essential uplan fee schedule · both	$1.8k	$1.8k	—	—	—	$1.8k – $1.8k
20	Medica choice with fee schedule · both	$1.8k	$1.8k	—	—	—	$1.8k – $1.8k
21	Ucare ifp fee schedule · outpatient	$2.0k	$2.0k	—	—	—	$2.0k – $2.0k
22	Cigna commercial fee schedule · outpatient	$2.4k	$2.4k	$205	9%	—	$2.2k – $2.6k

Last updated: May 18, 2026

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