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Illinois rates for HCPCS L7404

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

Facilitymedian $759 · 10th–90th $331–$3,4670%20%10th90th$759Professionalmedian $380 · 10th–90th $295–$6920%20%10th90th$380$1.0$5.0$20.0$100.0$500.0$2.0K$10.0K

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
$331.13 / $331.13 / $691.83
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$288.40 / $346.74 / $660.69
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$812.83 / $1,288.25 / $4,677.35
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$512.86 / $512.86 / $512.86
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$436.52 / $436.52 / $741.31
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$316.23 / $316.23 / $776.25
Hally Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$575.44 / $776.25 / $977.24
Hally Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$100.00 / $100.00 / $100.00
Hally Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$870.96 / $870.96 / $870.96
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$398.11 / $549.54 / $977.24
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$263.03 / $331.13 / $562.34