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Wisconsin rates for HCPCS L7401

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

Facilitymedian $427 · 10th–90th $380$7760%50%10th90th$427Professionalmedian $302 · 10th–90th $182$6310%10%20%10th90th$302$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
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$208.93 / $208.93 / $208.93
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$177.83 / $208.93 / $346.74
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$426.58 / $426.58 / $691.83
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$363.08 / $389.05 / $467.74
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$269.15 / $977.24 / $2,089.30
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$194.98 / $602.56 / $794.33
DeanCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$204.17 / $338.84 / $524.81
DeanCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$380.19 / $501.19 / $616.60
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$208.93 / $416.87 / $1,949.84
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$190.55 / $263.03 / $467.74
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$54.95 / $64.57 / $85.11
Network Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$660.69 / $660.69 / $660.69
Network Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$302.00 / $478.63 / $831.76
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$426.58 / $630.96 / $1,174.90
Quartz
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$269.15 / $831.76 / $1,949.84
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$194.98 / $389.05 / $2,089.30
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$218.78 / $275.42 / $426.58
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$162.18 / $208.93 / $346.74