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Wisconsin rates for HCPCS L5781

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

Facilitymedian $4,898 · 10th–90th $4,365$8,9130%20%40%10th90th$4,898Professionalmedian $3,548 · 10th–90th $2,138$7,4130%20%10th90th$3,548$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
$2,454.71 / $2,454.71 / $2,454.71
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,089.30 / $2,454.71 / $4,073.80
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$4,897.79 / $4,897.79 / $8,128.31
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$4,168.69 / $4,570.88 / $5,495.41
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,884.03 / $11,220.18 / $23,988.33
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,089.30 / $7,079.46 / $9,332.54
DeanCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,398.83 / $3,981.07 / $6,025.60
DeanCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$4,365.16 / $5,888.44 / $7,244.36
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,454.71 / $4,786.30 / $22,387.21
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,187.76 / $3,090.30 / $5,495.41
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$54.95 / $70.79 / $3,235.94
Network Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$7,762.47 / $7,762.47 / $7,762.47
Network Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3,467.37 / $5,495.41 / $9,772.37
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$4,897.79 / $7,413.10 / $13,489.63
Quartz
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,884.03 / $9,772.37 / $22,387.21
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,089.30 / $4,168.69 / $24,547.09
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,570.40 / $3,235.94 / $4,897.79
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,862.09 / $2,398.83 / $3,981.07