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Montana rates for HCPCS L7404

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

Facilitymedian $661 · 10th–90th $437$8320%20%10th90th$661Professionalmedian $427 · 10th–90th $214$8320%10%20%10th90th$427$100.0$200.0$500.0$1.0K$2.0K

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
Professional
Modifier
Global
Typical Low
$213.80
Median
$398.11
Typical High
$588.84
Cigna
Setting
Facility
Modifier
Global
Typical Low
$436.52
Median
$707.95
Typical High
$707.95
Cigna
Setting
Professional
Modifier
Global
Typical Low
$436.52
Median
$707.95
Typical High
$707.95
MountainHealth Co-op
Setting
Facility
Modifier
Global
Typical Low
$524.81
Median
$660.69
Typical High
$1,288.25
MountainHealth Co-op
Setting
Professional
Modifier
Global
Typical Low
$524.81
Median
$660.69
Typical High
$1,288.25
Providence
Setting
Facility
Modifier
Global
Typical Low
$316.23
Median
$630.96
Typical High
$954.99
Providence
Setting
Professional
Modifier
Global
Typical Low
$79.43
Median
$537.03
Typical High
$707.95
United
Setting
Facility
Modifier
Global
Typical Low
$398.11
Median
$446.68
Typical High
$478.63
United
Setting
Professional
Modifier
Global
Typical Low
$269.15
Median
$302.00
Typical High
$457.09