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Utah rates for HCPCS L5781

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

Facilitymedian $2,884 · 10th–90th $1,380–$4,8980%20%40%10th90th$2,884Professionalmedian $3,467 · 10th–90th $1,380–$20,4170%10%10th90th$3,467$50.0$200.0$1.0K$5.0K$20.0K

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,380.38 / $1,380.38 / $1,380.38
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,380.38 / $2,570.40 / $20,417.38
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,884.03 / $2,884.03 / $2,884.03
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,089.30 / $2,089.30 / $2,884.03
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$60.26 / $3,548.13 / $4,677.35
Regence BlueShield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$4,677.35 / $4,897.79 / $4,897.79
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3,388.44 / $3,467.37 / $5,248.07
Select Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$4,677.35 / $4,897.79 / $5,011.87
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3,467.37 / $5,011.87 / $5,754.40
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,778.28 / $2,818.38 / $3,235.94
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,698.24 / $2,137.96 / $3,630.78