Mastectomy bra with built-in breast forms, both sides 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

Brst prsth bra & bilat form

Maple Grove, MN

See all hospitals reporting HCPCS L8002 →

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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 $223 is 7% above the median hospital's median price ($208), higher than 75% of the 863 hospitals reporting HCPCS L8002. The highlighted bar is where this hospital falls; shaded is the middle 50% of hospitals.

Payers reporting HCPCS L8002 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	$171	$171	—	—	—	$171 – $171
2	Blue Cross Blue Shield commercial fee schedule · outpatient	$174	$174	—	—	—	$174 – $174
3	Blue Cross Blue Shield medicaid fee schedule · outpatient	$174	$174	—	—	—	$174 – $174
4	Blue Cross Blue Shield federal fee schedule · both	$185	$185	—	—	—	$185 – $185
5	Blue Cross Blue Shield commercial fee schedule · both	$188	$188	—	—	—	$188 – $188
6	Medica accessability fee schedule · both	$195	$195	—	—	—	$195 – $195
7	Medica medicaid fee schedule · both	$195	$195	—	—	—	$195 – $195
8	Medica ma non-snp fee schedule · both	$211	$211	—	—	—	$211 – $211
9	Medica ma snp fee schedule · both	$211	$211	—	—	—	$211 – $211
10	Medica prime solution fee schedule · both	$211	$211	—	—	—	$211 – $211
11	Medica vantage fee schedule · both	$211	$211	—	—	—	$211 – $211
12	Blue Cross Blue Shield medicaid fee schedule · both	$212	$212	—	—	—	$212 – $212
13	Ucare mhcp fee schedule · both	$217	$217	—	—	—	$217 – $217
14	Cigna commercial fee schedule · both	$261	$261	$23	9%	—	$238 – $283
15	Ucare ifp with fairview fee schedule · outpatient	$350	$350	—	—	—	$350 – $350
16	Medica bold fee schedule · both	$367	$367	—	—	—	$367 – $367
17	UnitedHealthcare commercial fee schedule · both	$381	$381	—	—	—	$381 – $381
18	Medica choice without / elect fee schedule · both	$407	$407	—	—	—	$407 – $407
19	Medica city of st paul / essential uplan fee schedule · both	$407	$407	—	—	—	$407 – $407
20	Medica choice with fee schedule · both	$422	$422	—	—	—	$422 – $422
21	Ucare ifp fee schedule · outpatient	$467	$467	—	—	—	$467 – $467
22	Cigna commercial fee schedule · outpatient	$548	$548	$48	9%	—	$500 – $595

Last updated: May 18, 2026

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See Mastectomy bra with built-in breast forms, both sides pricing across every hospital in the network reporting it, or ask Claude or any MCP client directly — see how to connect.