Ocular conformer fabrication and fitting 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.

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Generated: October 20, 2026

Original text from hospital filings

Fabrication & fitting

Maple Grove, MN

See all hospitals reporting HCPCS V2628 →

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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 $408 is 3% below the median hospital's median price ($421), higher than 41% of the 805 hospitals reporting HCPCS V2628. The highlighted bar is where this hospital falls; shaded is the middle 50% of hospitals.

Payers reporting HCPCS V2628 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	Medica accessability fee schedule · both	$286	$286	—	—	—	$286 – $286
2	Medica medicaid fee schedule · both	$286	$286	—	—	—	$286 – $286
3	Blue Cross Blue Shield medicaid fee schedule · both	$311	$311	—	—	—	$311 – $311
4	Ucare mhcp fee schedule · both	$311	$311	—	—	—	$311 – $311
5	Blue Cross Blue Shield federal fee schedule · both	$351	$351	—	—	—	$351 – $351
6	Blue Cross Blue Shield federal fee schedule · outpatient	$351	$351	—	—	—	$351 – $351
7	Blue Cross Blue Shield commercial fee schedule · both	$358	$358	—	—	—	$358 – $358
8	Blue Cross Blue Shield commercial fee schedule · outpatient	$358	$358	—	—	—	$358 – $358
9	Blue Cross Blue Shield medicaid fee schedule · outpatient	$358	$358	—	—	—	$358 – $358
10	Medica ma non-snp fee schedule · both	$387	$387	—	—	—	$387 – $387
11	Medica ma snp fee schedule · both	$387	$387	—	—	—	$387 – $387
12	Medica prime solution fee schedule · both	$387	$387	—	—	—	$387 – $387
13	Medica vantage fee schedule · both	$387	$387	—	—	—	$387 – $387
14	Cigna commercial fee schedule · both	$478	$478	$42	9%	—	$437 – $520
15	Ucare ifp with fairview fee schedule · outpatient	$642	$642	—	—	—	$642 – $642
16	Medica bold fee schedule · both	$672	$672	—	—	—	$672 – $672
17	Medica choice without / elect fee schedule · both	$747	$747	—	—	—	$747 – $747
18	Medica city of st paul / essential uplan fee schedule · both	$747	$747	—	—	—	$747 – $747
19	Medica choice with fee schedule · both	$773	$773	—	—	—	$773 – $773
20	UnitedHealthcare commercial fee schedule · both	$782	$782	—	—	—	$782 – $782
21	Ucare ifp fee schedule · outpatient	$856	$856	—	—	—	$856 – $856
22	Cigna commercial fee schedule · outpatient	$1.0k	$1.0k	$87	9%	—	$917 – $1.1k

Last updated: May 18, 2026

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See Ocular conformer fabrication and fitting pricing across every hospital in the network reporting it, or ask Claude or any MCP client directly — see how to connect.