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Above Elbow Disarticulation, Ultra-Light Material

Washington 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 $275$9770%20%10th90th$407Professionalmedian $339 · 10th–90th $195$7240%10%20%10th90th$339$5.0$20.0$100.0$500.0$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. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$263.03
Median
$263.03
Typical High
$616.60
Aetna
Setting
Professional
Modifier
Global
Typical Low
$208.93
Median
$263.03
Typical High
$1,737.80
Asuris Northwest Health
Setting
Facility
Modifier
Global
Typical Low
$389.05
Median
$398.11
Typical High
$407.38
Asuris Northwest Health
Setting
Professional
Modifier
Global
Typical Low
$346.74
Median
$346.74
Typical High
$457.09
Cigna
Setting
Facility
Modifier
Global
Typical Low
$269.15
Median
$269.15
Typical High
$269.15
Cigna
Setting
Professional
Modifier
Global
Typical Low
$194.98
Median
$194.98
Typical High
$269.15
Kaiser Permanente
Setting
Facility
Modifier
Global
Typical Low
$257.04
Median
$549.54
Typical High
$1,148.15
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$245.47
Median
$478.63
Typical High
$851.14
Molina
Setting
Professional
Modifier
Global
Typical Low
$75.86
Median
$281.84
Typical High
$338.84
Pacific Source
Setting
Facility
Modifier
Global
Typical Low
$398.11
Median
$407.38
Typical High
$407.38
Premera BCBS
Setting
Facility
Modifier
Global
Typical Low
$354.81
Median
$588.84
Typical High
$812.83
Premera BCBS
Setting
Professional
Modifier
Global
Typical Low
$338.84
Median
$338.84
Typical High
$398.11
Regence BlueShield
Setting
Facility
Modifier
Global
Typical Low
$398.11
Median
$398.11
Typical High
$407.38
Regence BlueShield
Setting
Professional
Modifier
Global
Typical Low
$346.74
Median
$346.74
Typical High
$457.09
United
Setting
Facility
Modifier
Global
Typical Low
$245.47
Median
$602.56
Typical High
$602.56
United
Setting
Professional
Modifier
Global
Typical Low
$173.78
Median
$251.19
Typical High
$354.81
Wellpoint
Setting
Professional
Modifier
Global
Typical Low
$251.19
Median
$288.40
Typical High
$616.60