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.
Original text from hospital filings
Ak/knee disartic acrylic soc
Maple Grove, MN
See all hospitals reporting HCPCS L5631 →Price type
Fairview Maple Grove Surgery Center’s median price of $590 is about the same as the median hospital's median price ($593), higher than 49% of the 848 hospitals reporting HCPCS L5631. The highlighted bar is where this hospital falls; shaded is the middle 50% of hospitals.
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 | $452 | $452 | — | — | — | $452 – $452 |
| 2 | Blue Cross Blue Shield commercial fee schedule · outpatient | $460 | $460 | — | — | — | $460 – $460 |
| 3 | Blue Cross Blue Shield medicaid fee schedule · outpatient | $460 | $460 | — | — | — | $460 – $460 |
| 4 | Blue Cross Blue Shield federal fee schedule · both | $489 | $489 | — | — | — | $489 – $489 |
| 5 | Blue Cross Blue Shield commercial fee schedule · both | $498 | $498 | — | — | — | $498 – $498 |
| 6 | Medica accessability fee schedule · both | $515 | $515 | — | — | — | $515 – $515 |
| 7 | Medica medicaid fee schedule · both | $515 | $515 | — | — | — | $515 – $515 |
| 8 | Medica ma non-snp fee schedule · both | $559 | $559 | — | — | — | $559 – $559 |
| 9 | Medica ma snp fee schedule · both | $559 | $559 | — | — | — | $559 – $559 |
| 10 | Medica prime solution fee schedule · both | $559 | $559 | — | — | — | $559 – $559 |
| 11 | Medica vantage fee schedule · both | $559 | $559 | — | — | — | $559 – $559 |
| 12 | Blue Cross Blue Shield medicaid fee schedule · both | $561 | $561 | — | — | — | $561 – $561 |
| 13 | Ucare mhcp fee schedule · both | $574 | $574 | — | — | — | $574 – $574 |
| 14 | Cigna commercial fee schedule · both | $691 | $691 | $60 | 9% | — | $631 – $751 |
| 15 | Ucare ifp with fairview fee schedule · outpatient | $927 | $927 | — | — | — | $927 – $927 |
| 16 | Medica bold fee schedule · both | $971 | $971 | — | — | — | $971 – $971 |
| 17 | Medica choice without / elect fee schedule · both | $1.1k | $1.1k | — | — | — | $1.1k – $1.1k |
| 18 | Medica city of st paul / essential uplan fee schedule · both | $1.1k | $1.1k | — | — | — | $1.1k – $1.1k |
| 19 | Medica choice with fee schedule · both | $1.1k | $1.1k | — | — | — | $1.1k – $1.1k |
| 20 | UnitedHealthcare commercial fee schedule · both | $1.1k | $1.1k | — | — | — | $1.1k – $1.1k |
| 21 | Ucare ifp fee schedule · outpatient | $1.2k | $1.2k | — | — | — | $1.2k – $1.2k |
| 22 | Cigna commercial fee schedule · outpatient | $1.5k | $1.5k | $126 | 9% | — | $1.3k – $1.6k |
Last updated: May 18, 2026
See Acrylic socket addition for above-knee prosthesis pricing across every hospital in the network reporting it, or ask Claude or any MCP client directly — see how to connect.