go back

Pennsylvania rates for HCPCS L7404

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

Facilitymedian $813 · 10th–90th $295$1,1220%20%10th90th$813Professionalmedian $331 · 10th–90th $288$5890%20%10th90th$331$0.5$5.0$50.0$500.0$5.0K$50.0K

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
$295.12 / $1,122.02 / $1,122.02
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$281.84 / $323.59 / $562.34
Capital Blue Cross
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$5,011.87 / $8,511.38 / $77,624.71
Capital Blue Cross
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$660.69 / $660.69 / $660.69
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$436.52 / $436.52 / $660.69
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$316.23 / $316.23 / $436.52
Emblem Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$616.60 / $870.96 / $1,258.93
Geisinger
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$660.69 / $660.69 / $660.69
Geisinger
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$398.11 / $467.74 / $660.69
Highmark BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$489.78 / $489.78 / $489.78
Martin's Point
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$295.12 / $295.12 / $295.12
Martin's Point
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$288.40 / $331.13 / $562.34
Oscar Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.60 / $933.25 / $1,288.25
UPMC Health Plan
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$467.74 / $467.74 / $616.60
UPMC Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$467.74 / $575.44 / $616.60
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$269.15 / $812.83 / $933.25
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$275.42 / $363.08 / $660.69