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California rates for HCPCS L7404

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

Facilitymedian $347 · 10th–90th $275$1,5850%20%10th90th$347Professionalmedian $372 · 10th–90th $295$2,4550%20%10th90th$372$0.5$2.0$10.0$50.0$200.0$1.0K$5.0K

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
$363.08 / $363.08 / $2,818.38
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$288.40 / $363.08 / $2,511.89
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$275.42 / $346.74 / $1,479.11
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$363.08 / $407.38 / $954.99
Blue Shield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$398.11 / $954.99 / $1,548.82
Blue Shield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$630.96 / $1,202.26 / $2,454.71
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 / $436.52
Contra Costa Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$346.74 / $436.52 / $794.33
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$398.11 / $602.56 / $1,047.13
Lucent Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$3,162.28 / $3,162.28 / $3,162.28
Lucent Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3,467.37 / $4,897.79 / $4,897.79
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$676.08 / $676.08 / $676.08
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$204.17 / $660.69 / $891.25
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$316.23 / $316.23 / $645.65
Sutter Health Plus
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,230.27 / $1,230.27 / $1,230.27
The Alliance
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$346.74 / $457.09 / $602.56
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$48.98 / $398.11 / $812.83
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$281.84 / $363.08 / $707.95