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Utah rates for HCPCS L7401

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$119.17 / $119.17 / $119.17
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$119.17 / $130.97 / $1,166.48
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$267.94 / $267.94 / $267.94
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$195.60 / $267.94 / $285.63
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$189.54 / $305.72 / $397.43
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$366.70 / $408.96 / $408.96
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$232.88 / $293.14 / $439.72
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$166.68 / $184.60 / $264.83