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Washington rates for HCPCS L5781

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

Facilitymedian $4,786 · 10th–90th $3,090–$11,4820%20%10th90th$4,786Professionalmedian $3,388 · 10th–90th $2,089–$6,9180%10%20%10th90th$3,388$1.0$5.0$20.0$100.0$500.0$2.0K$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
$3,090.30 / $3,090.30 / $7,244.36
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,089.30 / $2,570.40 / $4,265.80
Ambetter
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3,548.13 / $3,548.13 / $3,548.13
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$4,073.80 / $4,570.88 / $4,570.88
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$4,073.80 / $4,073.80 / $5,248.07
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
Kaiser Permanente
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,691.53 / $6,456.54 / $13,182.57
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,691.53 / $5,623.41 / $10,000.00
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$75.86 / $3,630.78 / $3,981.07
Pacific Source
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$4,570.88 / $4,677.35 / $4,786.30
Premera BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$4,168.69 / $6,918.31 / $9,332.54
Premera BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3,890.45 / $3,890.45 / $4,570.88
Regence BlueShield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$4,570.88 / $4,570.88 / $4,570.88
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$4,073.80 / $4,073.80 / $5,248.07
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,818.38 / $7,079.46 / $7,079.46
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,041.74 / $2,884.03 / $4,073.80
Wellpoint
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3,388.44 / $4,073.80 / $7,244.36