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South Dakota rates for HCPCS L7404

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

Facilitymedian $562 · 10th–90th $501$1,1220%20%40%10th90th$562Professionalmedian $562 · 10th–90th $295$8910%10%10th90th$562$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. Small sample — interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$489.78
Median
$562.34
Typical High
$562.34
Aetna
Setting
Professional
Modifier
Global
Typical Low
$295.12
Median
$549.54
Typical High
$660.69
Cigna
Setting
Facility
Modifier
Global
Typical Low
$436.52
Median
$436.52
Typical High
$741.31
Cigna
Setting
Professional
Modifier
Global
Typical Low
$776.25
Median
$776.25
Typical High
$977.24
Medica
Setting
Facility
Modifier
Global
Typical Low
$537.03
Median
$691.83
Typical High
$1,819.70
Medica
Setting
Professional
Modifier
Global
Typical Low
$269.15
Median
$457.09
Typical High
$3,388.44
Midlands
Setting
Professional
Modifier
Global
Typical Low
$616.60
Median
$724.44
Typical High
$741.31
Midlands
Setting
Facility
Modifier
Global
Typical Low
$741.31
Median
$741.31
Typical High
$741.31
Midlands
Setting
Professional
Modifier
Global
Typical Low
$616.60
Median
$616.60
Typical High
$1,202.26
Sanford Health Plan
Setting
Professional
Modifier
Global
Typical Low
$562.34
Median
$676.08
Typical High
$891.25
United
Setting
Professional
Modifier
Global
Typical Low
$234.42
Median
$457.09
Typical High
$794.33
Wellmark
Setting
Professional
Modifier
Global
Typical Low
$660.69
Median
$660.69
Typical High
$660.69