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Montana rates for HCPCS L7401

Addition to upper extremity prosthesis, above elbow disarticulation, ultra-light material (titanium, carbon fiber or equal)

Facilitymedian $407 · 10th–90th $269–$5130%20%40%10th90th$407Professionalmedian $263 · 10th–90th $129–$5130%10%10th90th$263$100.0$200.0$500.0$1.0K

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
Professional
Modifier
Typical Low / Median / Typical High
$128.82 / $245.47 / $363.08
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$269.15 / $436.52 / $436.52
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$269.15 / $436.52 / $436.52
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$323.59 / $407.38 / $794.33
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$323.59 / $407.38 / $794.33
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$194.98 / $389.05 / $588.84
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$79.43 / $331.13 / $436.52
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$245.47 / $275.42 / $295.12
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$165.96 / $186.21 / $281.84