Above-knee prosthetic pelvic control sleeve suspension addition 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
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Reasoning effort: low
Max output tokens: 4096
Prompt version (hash): 444523875572
Generated: October 20, 2026

Original text from hospital filings

Ak sleeve susp neoprene/equa

Maple Grove, MN

See all hospitals reporting HCPCS L5695 →

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How this price compares nationally

Fairview Maple Grove Surgery Center’s median price of $219 is 8% below the median hospital's median price ($238), higher than 38% of the 901 hospitals reporting HCPCS L5695. The highlighted bar is where this hospital falls; shaded is the middle 50% of hospitals.

Payers reporting HCPCS L5695 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	$168	$168	—	—	—	$168 – $168
2	Blue Cross Blue Shield commercial fee schedule · outpatient	$171	$171	—	—	—	$171 – $171
3	Blue Cross Blue Shield medicaid fee schedule · outpatient	$171	$171	—	—	—	$171 – $171
4	Blue Cross Blue Shield federal fee schedule · both	$182	$182	—	—	—	$182 – $182
5	Blue Cross Blue Shield commercial fee schedule · both	$185	$185	—	—	—	$185 – $185
6	Medica accessability fee schedule · both	$191	$191	—	—	—	$191 – $191
7	Medica medicaid fee schedule · both	$191	$191	—	—	—	$191 – $191
8	Medica ma non-snp fee schedule · both	$207	$207	—	—	—	$207 – $207
9	Medica ma snp fee schedule · both	$207	$207	—	—	—	$207 – $207
10	Medica prime solution fee schedule · both	$207	$207	—	—	—	$207 – $207
11	Medica vantage fee schedule · both	$207	$207	—	—	—	$207 – $207
12	Blue Cross Blue Shield medicaid fee schedule · both	$208	$208	—	—	—	$208 – $208
13	Ucare mhcp fee schedule · both	$213	$213	—	—	—	$213 – $213
14	Cigna commercial fee schedule · both	$256	$256	$22	9%	—	$234 – $279
15	Ucare ifp with fairview fee schedule · outpatient	$344	$344	—	—	—	$344 – $344
16	Medica bold fee schedule · both	$360	$360	—	—	—	$360 – $360
17	Medica choice without / elect fee schedule · both	$400	$400	—	—	—	$400 – $400
18	Medica city of st paul / essential uplan fee schedule · both	$400	$400	—	—	—	$400 – $400
19	Medica choice with fee schedule · both	$414	$414	—	—	—	$414 – $414
20	UnitedHealthcare commercial fee schedule · both	$419	$419	—	—	—	$419 – $419
21	Ucare ifp fee schedule · outpatient	$459	$459	—	—	—	$459 – $459
22	Cigna commercial fee schedule · outpatient	$538	$538	$47	9%	—	$492 – $585

Last updated: May 18, 2026

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