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Alaska rates for HCPCS L7404

Addition to upper extremity prosthesis, above elbow disarticulation, acrylic material

Facilitymedian $363 · 10th–90th $195–$6610%20%40%10th90th$363Professionalmedian $437 · 10th–90th $324–$8130%10%10th90th$437$100.0$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. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$316.23 / $426.58 / $588.84
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$436.52 / $436.52 / $436.52
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$316.23 / $316.23 / $724.44
Moda Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$194.98 / $467.74 / $645.65
Moda Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$363.08 / $630.96 / $2,137.96
Premera BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$575.44 / $645.65 / $660.69
Premera BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$524.81 / $645.65 / $660.69
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$194.98 / $194.98 / $660.69
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$60.26 / $436.52 / $616.60
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$398.11 / $398.11 / $446.68
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$316.23 / $323.59 / $1,445.44