Prosthetic arm addition: silicone gel liner 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

Silicon gel insert w/wo lock

Maple Grove, MN

See all hospitals reporting HCPCS L6692 →

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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 $864 is 6% above the median hospital's median price ($811), higher than 63% of the 815 hospitals reporting HCPCS L6692. The highlighted bar is where this hospital falls; shaded is the middle 50% of hospitals.

Payers reporting HCPCS L6692 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	$661	$661	—	—	—	$661 – $661
2	Blue Cross Blue Shield commercial fee schedule · outpatient	$673	$673	—	—	—	$673 – $673
3	Blue Cross Blue Shield medicaid fee schedule · outpatient	$673	$673	—	—	—	$673 – $673
4	Blue Cross Blue Shield federal fee schedule · both	$716	$716	—	—	—	$716 – $716
5	Blue Cross Blue Shield commercial fee schedule · both	$729	$729	—	—	—	$729 – $729
6	Medica accessability fee schedule · both	$754	$754	—	—	—	$754 – $754
7	Medica medicaid fee schedule · both	$754	$754	—	—	—	$754 – $754
8	Medica ma non-snp fee schedule · both	$818	$818	—	—	—	$818 – $818
9	Medica ma snp fee schedule · both	$818	$818	—	—	—	$818 – $818
10	Medica prime solution fee schedule · both	$818	$818	—	—	—	$818 – $818
11	Medica vantage fee schedule · both	$818	$818	—	—	—	$818 – $818
12	Blue Cross Blue Shield medicaid fee schedule · both	$821	$821	—	—	—	$821 – $821
13	Ucare mhcp fee schedule · both	$841	$841	—	—	—	$841 – $841
14	Cigna commercial fee schedule · both	$1.0k	$1.0k	$88	9%	—	$923 – $1.1k
15	Ucare ifp with fairview fee schedule · outpatient	$1.4k	$1.4k	—	—	—	$1.4k – $1.4k
16	Medica bold fee schedule · both	$1.4k	$1.4k	—	—	—	$1.4k – $1.4k
17	UnitedHealthcare commercial fee schedule · both	$1.4k	$1.4k	—	—	—	$1.4k – $1.4k
18	Medica choice without / elect fee schedule · both	$1.6k	$1.6k	—	—	—	$1.6k – $1.6k
19	Medica city of st paul / essential uplan fee schedule · both	$1.6k	$1.6k	—	—	—	$1.6k – $1.6k
20	Medica choice with fee schedule · both	$1.6k	$1.6k	—	—	—	$1.6k – $1.6k
21	Ucare ifp fee schedule · outpatient	$1.8k	$1.8k	—	—	—	$1.8k – $1.8k
22	Cigna commercial fee schedule · outpatient	$2.1k	$2.1k	$185	9%	—	$1.9k – $2.3k

Last updated: May 18, 2026

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