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Ohio rates for HCPCS L7404

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

Facilitymedian $724 · 10th–90th $398$1,2020%20%40%10th90th$724Professionalmedian $347 · 10th–90th $288$5890%20%40%10th90th$347$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
$323.59 / $323.59 / $562.34
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$281.84 / $323.59 / $549.54
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$691.83 / $724.44 / $1,479.11
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$338.84 / $416.87 / $891.25
Aultcare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$575.44 / $575.44 / $575.44
CareSource
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$338.84 / $575.44 / $812.83
CareSource
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$436.52 / $602.56 / $912.01
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
Medical Mutual of Ohio
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$436.52 / $436.52 / $436.52
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$316.23 / $316.23 / $436.52
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$363.08 / $575.44 / $831.76
SummaCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$812.83 / $812.83 / $812.83
SummaCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$645.65 / $758.58 / $1,412.54
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$269.15 / $549.54 / $812.83
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$223.87 / $331.13 / $457.09