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South Carolina rates for HCPCS L7404

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

Facilitymedian $447 · 10th–90th $302–$8510%10%20%10th90th$447Professionalmedian $339 · 10th–90th $282–$5500%20%10th90th$339$50.0$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
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$302.00 / $302.00 / $302.00
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$281.84 / $338.84 / $501.19
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$436.52 / $645.65 / $794.33
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$436.52 / $436.52 / $478.63
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$316.23 / $316.23 / $776.25
Medcost
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$338.84 / $338.84 / $338.84
Medcost
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$302.00 / $489.78 / $1,071.52
Medcost
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$194.98 / $194.98 / $194.98
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$30.20 / $30.20 / $30.20
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$398.11 / $446.68 / $812.83
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$251.19 / $331.13 / $457.09