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Washington rates for HCPCS L7404

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

Facilitymedian $661 · 10th–90th $427$1,5850%20%10th90th$661Professionalmedian $468 · 10th–90th $295$9550%20%10th90th$468$1.0$5.0$20.0$100.0$500.0$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
Facility
Modifier
Global
Typical Low
$426.58
Median
$426.58
Typical High
$1,000.00
Aetna
Setting
Professional
Modifier
Global
Typical Low
$288.40
Median
$363.08
Typical High
$588.84
Asuris Northwest Health
Setting
Facility
Modifier
Global
Typical Low
$562.34
Median
$645.65
Typical High
$645.65
Asuris Northwest Health
Setting
Professional
Modifier
Global
Typical Low
$562.34
Median
$562.34
Typical High
$741.31
Cigna
Setting
Facility
Modifier
Global
Typical Low
$436.52
Median
$436.52
Typical High
$436.52
Cigna
Setting
Professional
Modifier
Global
Typical Low
$316.23
Median
$316.23
Typical High
$436.52
Kaiser Permanente
Setting
Facility
Modifier
Global
Typical Low
$380.19
Median
$891.25
Typical High
$1,862.09
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$380.19
Median
$776.25
Typical High
$1,380.38
Molina
Setting
Professional
Modifier
Global
Typical Low
$75.86
Median
$501.19
Typical High
$549.54
Pacific Source
Setting
Facility
Modifier
Global
Typical Low
$524.81
Median
$645.65
Typical High
$660.69
Pacific Source
Setting
Professional
Modifier
Global
Typical Low
$660.69
Median
$660.69
Typical High
$724.44
Premera BCBS
Setting
Facility
Modifier
Global
Typical Low
$575.44
Median
$954.99
Typical High
$1,318.26
Premera BCBS
Setting
Professional
Modifier
Global
Typical Low
$549.54
Median
$549.54
Typical High
$645.65
Regence BlueShield
Setting
Facility
Modifier
Global
Typical Low
$645.65
Median
$645.65
Typical High
$645.65
Regence BlueShield
Setting
Professional
Modifier
Global
Typical Low
$562.34
Median
$562.34
Typical High
$741.31
United
Setting
Facility
Modifier
Global
Typical Low
$398.11
Median
$977.24
Typical High
$977.24
United
Setting
Professional
Modifier
Global
Typical Low
$281.84
Median
$398.11
Typical High
$575.44
Wellpoint
Setting
Professional
Modifier
Global
Typical Low
$407.38
Median
$467.74
Typical High
$1,000.00