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Pennsylvania rates for HCPCS L5781

Addition to lower limb prosthesis, vacuum pump, residual limb volume management and moisture evacuation system

Facilitymedian $5,012 · 10th–90th $2,089–$8,1280%20%10th90th$5,012Professionalmedian $2,344 · 10th–90th $2,042–$4,2660%50%10th90th$2,344$1.0$10.0$100.0$1.0K$10.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,089.30 / $8,128.31 / $8,128.31
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,041.74 / $2,344.23 / $4,073.80
Capital Blue Cross
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$5,011.87 / $8,511.38 / $77,624.71
Capital Blue Cross
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$4,677.35 / $4,677.35 / $4,677.35
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,884.03 / $2,884.03 / $4,570.88
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,089.30 / $2,089.30 / $2,884.03
Emblem Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$4,466.84 / $6,309.57 / $9,120.11
Geisinger
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$4,786.30 / $4,786.30 / $4,786.30
Geisinger
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,884.03 / $3,388.44 / $4,786.30
Highmark BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3,311.31 / $3,311.31 / $3,311.31
Martin's Point
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,089.30 / $2,089.30 / $2,089.30
Martin's Point
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,041.74 / $2,398.83 / $3,630.78
Oscar Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.60 / $6,760.83 / $9,332.54
UPMC Health Plan
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$3,388.44 / $3,388.44 / $4,466.84
UPMC Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3,388.44 / $3,388.44 / $4,570.88
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,949.84 / $5,888.44 / $6,760.83
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,041.74 / $2,630.27 / $4,786.30