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Minnesota rates for HCPCS L7404

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

Facilitymedian $794 · 10th–90th $575–$4,8980%20%10th90th$794Professionalmedian $676 · 10th–90th $324–$7760%50%10th90th$676$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
$562.34 / $562.34 / $562.34
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$288.40 / $398.11 / $562.34
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$660.69 / $676.08 / $870.96
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$537.03 / $676.08 / $676.08
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,548.82 / $2,511.89 / $6,025.60
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$776.25 / $891.25 / $977.24
Health Partners
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,995.26 / $2,511.89 / $4,897.79
Health Partners
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$776.25 / $776.25 / $1,047.13
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$281.84 / $676.08 / $3,090.30
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$199.53 / $302.00 / $741.31
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$4.79 / $398.11 / $977.24
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$223.87 / $354.81 / $933.25