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Indiana rates for HCPCS L7404

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

Facilitymedian $692 · 10th–90th $316$8510%20%40%10th90th$692Professionalmedian $339 · 10th–90th $295$5620%20%40%10th90th$339$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
Setting
Facility
Modifier
Global
Typical Low
$316.23
Median
$316.23
Typical High
$316.23
Aetna
Setting
Professional
Modifier
Global
Typical Low
$295.12
Median
$331.13
Typical High
$501.19
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$407.38
Median
$691.83
Typical High
$851.14
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$363.08
Median
$407.38
Typical High
$691.83
CareSource
Setting
Facility
Modifier
Global
Typical Low
$676.08
Median
$870.96
Typical High
$1,023.29
Cigna
Setting
Facility
Modifier
Global
Typical Low
$436.52
Median
$436.52
Typical High
$691.83
Cigna
Setting
Professional
Modifier
Global
Typical Low
$316.23
Median
$316.23
Typical High
$741.31
United
Setting
Facility
Modifier
Global
Typical Low
$398.11
Median
$457.09
Typical High
$549.54
United
Setting
Professional
Modifier
Global
Typical Low
$199.53
Median
$331.13
Typical High
$478.63