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Above Elbow Disarticulation, Ultra-Light Material

Wisconsin 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 $427 · 10th–90th $339$7760%50%10th90th$427Professionalmedian $389 · 10th–90th $209$7080%10%20%10th90th$389$0.5$2.0$10.0$50.0$200.0$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
Setting
Facility
Modifier
Global
Typical Low
$208.93
Median
$208.93
Typical High
$208.93
Aetna
Setting
Professional
Modifier
Global
Typical Low
$208.93
Median
$208.93
Typical High
$416.87
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$426.58
Median
$426.58
Typical High
$691.83
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$354.81
Median
$389.05
Typical High
$467.74
Cigna
Setting
Facility
Modifier
Global
Typical Low
$269.15
Median
$977.24
Typical High
$2,137.96
Cigna
Setting
Professional
Modifier
Global
Typical Low
$194.98
Median
$616.60
Typical High
$794.33
DeanCare
Setting
Facility
Modifier
Global
Typical Low
$204.17
Median
$338.84
Typical High
$524.81
DeanCare
Setting
Professional
Modifier
Global
Typical Low
$380.19
Median
$501.19
Typical High
$616.60
Medica
Setting
Facility
Modifier
Global
Typical Low
$208.93
Median
$416.87
Typical High
$1,949.84
Medica
Setting
Professional
Modifier
Global
Typical Low
$190.55
Median
$263.03
Typical High
$467.74
Molina
Setting
Professional
Modifier
Global
Typical Low
$54.95
Median
$64.57
Typical High
$85.11
Network Health
Setting
Facility
Modifier
Global
Typical Low
$660.69
Median
$660.69
Typical High
$660.69
Network Health
Setting
Professional
Modifier
Global
Typical Low
$302.00
Median
$478.63
Typical High
$831.76
Prevea360
Setting
Facility
Modifier
Global
Typical Low
$204.17
Median
$338.84
Typical High
$524.81
Prevea360
Setting
Professional
Modifier
Global
Typical Low
$239.88
Median
$407.38
Typical High
$416.87
Quartz
Setting
Professional
Modifier
Global
Typical Low
$426.58
Median
$630.96
Typical High
$1,096.48
Quartz
Setting
Facility
Modifier
Global
Typical Low
$269.15
Median
$851.14
Typical High
$1,949.84
Quartz
Setting
Professional
Modifier
Global
Typical Low
$194.98
Median
$630.96
Typical High
$2,137.96
United
Setting
Facility
Modifier
Global
Typical Low
$218.78
Median
$275.42
Typical High
$426.58
United
Setting
Professional
Modifier
Global
Typical Low
$154.88
Median
$218.78
Typical High
$380.19