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Missouri rates for HCPCS L7404

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

Facilitymedian $562 · 10th–90th $331–$1,3490%20%10th90th$562Professionalmedian $372 · 10th–90th $288–$6310%20%10th90th$372$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
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$302.00 / $446.68 / $446.68
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$281.84 / $346.74 / $630.96
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$676.08 / $676.08 / $2,398.83
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$354.81 / $407.38 / $630.96
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$407.38 / $407.38 / $676.08
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$436.52 / $436.52 / $457.09
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$316.23 / $316.23 / $436.52
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$331.13 / $537.03 / $1,479.11
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$234.42 / $338.84 / $3,388.44
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$398.11 / $549.54 / $549.54
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$251.19 / $331.13 / $489.78