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Idaho rates for HCPCS L7404

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

Facilitymedian $617 · 10th–90th $417–$7940%20%10th90th$617Professionalmedian $468 · 10th–90th $295–$7410%10%10th90th$468$50.0$100.0$200.0$500.0$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
Professional
Modifier
Typical Low / Median / Typical High
$295.12 / $398.11 / $562.34
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$524.81 / $616.60 / $1,047.13
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$691.83 / $741.31 / $741.31
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$407.38 / $436.52 / $457.09
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$316.23 / $316.23 / $436.52
Moda Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$194.98 / $630.96 / $707.95
Moda Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$398.11 / $602.56 / $660.69
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$30.20 / $30.20 / $562.34
Regence BlueShield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$616.60 / $645.65 / $645.65
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$467.74 / $467.74 / $707.95
Select Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$524.81 / $660.69 / $691.83
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$398.11 / $446.68 / $457.09
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$275.42 / $302.00 / $457.09