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Michigan rates for HCPCS L7404

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

Facilitymedian $813 · 10th–90th $380–$2,6920%10%10th90th$813Professionalmedian $372 · 10th–90th $295–$6760%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
$380.19 / $380.19 / $380.19
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$281.84 / $346.74 / $501.19
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$891.25 / $2,041.74 / $3,890.45
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$676.08 / $676.08 / $707.95
CareSource
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$436.52 / $436.52 / $436.52
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 / $436.52 / $741.31
Health Alliance Plan
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$380.19 / $1,288.25 / $1,412.54
Health Alliance Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$346.74 / $537.03 / $812.83
Priority Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$436.52 / $436.52 / $436.52
Priority Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$316.23 / $467.74 / $676.08
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$398.11 / $549.54 / $812.83
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$251.19 / $316.23 / $457.09