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Above Elbow Disarticulation, Ultra-Light Material

South Dakota 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 $407 · 10th–90th $282$8130%10%10th90th$407Professionalmedian $407 · 10th–90th $324$6030%20%10th90th$407$200.0$500.0$1.0K$2.0K

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
Setting
Facility
Modifier
Global
Typical Low
$302.00
Median
$302.00
Typical High
$302.00
Aetna
Setting
Professional
Modifier
Global
Typical Low
$323.59
Median
$346.74
Typical High
$407.38
Cigna
Setting
Facility
Modifier
Global
Typical Low
$269.15
Median
$269.15
Typical High
$467.74
Cigna
Setting
Professional
Modifier
Global
Typical Low
$478.63
Median
$478.63
Typical High
$602.56
Medica
Setting
Facility
Modifier
Global
Typical Low
$331.13
Median
$426.58
Typical High
$1,122.02
Medica
Setting
Professional
Modifier
Global
Typical Low
$165.96
Median
$281.84
Typical High
$2,089.30
Midlands
Setting
Professional
Modifier
Global
Typical Low
$380.19
Median
$457.09
Typical High
$457.09
Midlands
Setting
Facility
Modifier
Global
Typical Low
$467.74
Median
$467.74
Typical High
$467.74
Midlands
Setting
Professional
Modifier
Global
Typical Low
$380.19
Median
$380.19
Typical High
$758.58
Sanford Health Plan
Setting
Professional
Modifier
Global
Typical Low
$346.74
Median
$416.87
Typical High
$549.54
United
Setting
Facility
Modifier
Global
Typical Low
$245.47
Median
$275.42
Typical High
$309.03
United
Setting
Professional
Modifier
Global
Typical Low
$144.54
Median
$281.84
Typical High
$489.78
Wellmark
Setting
Professional
Modifier
Global
Typical Low
$407.38
Median
$407.38
Typical High
$407.38