Amniotic tissue fluid graft, per 1 mg 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-sonnet-5-5
Provider: anthropic
API: message_batches
Reasoning effort: model default
Max output tokens: 4096
Prompt version (hash): 444523875572
Generated: October 20, 2026

Original text from hospital filings

Neoxflo or clarixflo 1 mg

Maple Grove, MN

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How this price compares nationally

Fairview Maple Grove Surgery Center’s median price of $47 is 5% below the median hospital's median price ($50), higher than 47% of the 1,067 hospitals reporting HCPCS Q4155. The highlighted bar is where this hospital falls; shaded is the middle 50% of hospitals.

Payers reporting HCPCS Q4155 at Fairview Maple Grove Surgery Center

Negotiated rates from the hospital’s own file: 3 payers, 12 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	Medica ma non-snp fee schedule · both	$30	$30	—	—	—	$30 – $30
2	Medica ma snp fee schedule · both	$30	$30	—	—	—	$30 – $30
3	Medica prime solution fee schedule · both	$30	$30	—	—	—	$30 – $30
4	Medica vantage fee schedule · both	$30	$30	—	—	—	$30 – $30
5	UnitedHealthcare commercial fee schedule · both	$48	$48	—	—	—	$48 – $48
6	Medica bold fee schedule · both	$62	$62	—	—	—	$62 – $62
7	Medica choice without / elect fee schedule · both	$69	$69	—	—	—	$69 – $69
8	Medica city of st paul / essential uplan fee schedule · both	$69	$69	—	—	—	$69 – $69
9	Medica choice with fee schedule · both	$71	$71	—	—	—	$71 – $71
10	Blue Cross Blue Shield medicaid fee schedule · outpatient	$211	$211	—	—	—	$211 – $211
11	Blue Cross Blue Shield federal fee schedule · outpatient	$348	$348	—	—	—	$348 – $348
12	Blue Cross Blue Shield commercial fee schedule · outpatient	$354	$354	—	—	—	$354 – $354

Last updated: May 18, 2026

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