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Above Elbow Disarticulation, Ultra-Light Material

Pennsylvania rates for HCPCS L7401

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

Rates data updated July 2026.

Facilitymedian $501 · 10th–90th $182$1,9500%20%10th90th$501Professionalmedian $200 · 10th–90th $166$4070%20%10th90th$200$0.5$5.0$50.0$500.0$5.0K$50.0K

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
Setting
Facility
Modifier
Global
Typical Low
$181.97
Median
$181.97
Typical High
$691.83
Aetna
Setting
Professional
Modifier
Global
Typical Low
$158.49
Median
$199.53
Typical High
$309.03
Capital Blue Cross
Setting
Facility
Modifier
Global
Typical Low
$5,011.87
Median
$8,511.38
Typical High
$77,624.71
Capital Blue Cross
Setting
Professional
Modifier
Global
Typical Low
$407.38
Median
$407.38
Typical High
$407.38
Cigna
Setting
Facility
Modifier
Global
Typical Low
$269.15
Median
$269.15
Typical High
$575.44
Cigna
Setting
Professional
Modifier
Global
Typical Low
$194.98
Median
$194.98
Typical High
$269.15
Emblem Health
Setting
Professional
Modifier
Global
Typical Low
$380.19
Median
$537.03
Typical High
$776.25
Geisinger
Setting
Facility
Modifier
Global
Typical Low
$416.87
Median
$416.87
Typical High
$416.87
Geisinger
Setting
Professional
Modifier
Global
Typical Low
$245.47
Median
$288.40
Typical High
$416.87
Highmark BCBS
Setting
Professional
Modifier
Global
Typical Low
$302.00
Median
$302.00
Typical High
$302.00
Martin's Point
Setting
Facility
Modifier
Global
Typical Low
$181.97
Median
$181.97
Typical High
$691.83
Martin's Point
Setting
Professional
Modifier
Global
Typical Low
$177.83
Median
$199.53
Typical High
$309.03
Oscar Health
Setting
Professional
Modifier
Global
Typical Low
$371.54
Median
$371.54
Typical High
$371.54
UPMC Health Plan
Setting
Facility
Modifier
Global
Typical Low
$389.05
Median
$1,445.44
Typical High
$2,344.23
UPMC Health Plan
Setting
Professional
Modifier
Global
Typical Low
$288.40
Median
$389.05
Typical High
$398.11
United
Setting
Facility
Modifier
Global
Typical Low
$165.96
Median
$501.19
Typical High
$501.19
United
Setting
Professional
Modifier
Global
Typical Low
$165.96
Median
$229.09
Typical High
$416.87