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Wisconsin rates for HCPCS L7404

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

Facilitymedian $692 · 10th–90th $603$1,2590%50%10th90th$692Professionalmedian $490 · 10th–90th $295$1,0230%10%20%10th90th$490$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
$338.84 / $338.84 / $338.84
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$288.40 / $338.84 / $562.34
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$691.83 / $691.83 / $1,122.02
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$575.44 / $630.96 / $758.58
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$436.52 / $1,584.89 / $3,388.44
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$316.23 / $977.24 / $1,288.25
DeanCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$331.13 / $549.54 / $851.14
DeanCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$616.60 / $831.76 / $1,047.13
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$338.84 / $676.08 / $3,090.30
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$309.03 / $426.58 / $758.58
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$54.95 / $64.57 / $85.11
Network Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,071.52 / $1,071.52 / $1,071.52
Network Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$489.78 / $776.25 / $1,348.96
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$691.83 / $1,023.29 / $1,905.46
Quartz
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$436.52 / $1,348.96 / $3,090.30
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$316.23 / $630.96 / $3,388.44
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$354.81 / $446.68 / $691.83
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$263.03 / $331.13 / $562.34