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Utah rates for HCPCS L7402

Addition To Upper Extremity Prosthesis Shoulder Disarticulation/Interscapular Thoracic Ultralight Material (Titanium Carbon Fiber Or Equal)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$128.69 / $128.69 / $128.69
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$128.69 / $141.44 / $1,259.71
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$318.35 / $318.35 / $318.35
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$232.40 / $318.35 / $339.37
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$204.67 / $330.12 / $429.15
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$395.97 / $441.61 / $441.61
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$251.48 / $316.55 / $474.82
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$180.00 / $199.36 / $278.48