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Utah rates for HCPCS L7400

Addition To Upper Extremity Prosthesis Below Elbow Elbow/Wrist Disarticulation Ultralight Material (Titanium Carbon Fiber Or Equal)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$106.46 / $106.46 / $106.46
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$106.46 / $117.00 / $1,041.97
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$239.35 / $239.35 / $239.35
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$174.73 / $174.73 / $433.29
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$169.30 / $273.08 / $355.00
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$327.54 / $365.30 / $365.30
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$208.02 / $261.85 / $392.77
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$129.12 / $164.90 / $236.57