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Below Elbow or Wrist Disarticulation, Acrylic Material

Utah rates for HCPCS L7403

Addition to upper extremity prosthesis, below elbow/wrist disarticulation, acrylic material

Rates data updated October 2026.

How much does Below Elbow or Wrist Disarticulation, Acrylic Material cost?

$288

Typical negotiated rate. In Utah, October 2026.

Insurers have agreed to pay about $288 for this service. The price depends on where it is billed: about $288 from a physician practice, and about $288 from a hospital or other facility.

These are rates insurers have negotiated with providers, not the amount a patient is billed. What you owe depends on your plan's deductible and coinsurance. Based on rates published by 7 insurance carriers under federal price transparency rules.

Prices by location type

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$288$200 to $331
FacilityA hospital or hospital-owned outpatient department$288$129 to $447

How much rates vary

Facilitymedian $288 · 10th to 90th $129 to $447Professionalmedian $288 · 10th to 90th $129 to $407
$100$200$500facility $288professional $288

Distribution of negotiated rates across all payers (price axis is log-scale). Small sample; interpret with caution. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Facility
Modifier
None
Typical Low
$128.82
Median
$128.82
Typical High
$128.82
Aetna
Setting
Professional
Modifier
None
Typical Low
$128.82
Median
$128.82
Typical High
$141.25
Cigna
Setting
Facility
Modifier
None
Typical Low
$288.40
Median
$288.40
Typical High
$316.23
Cigna
Setting
Professional
Modifier
None
Typical Low
$208.93
Median
$208.93
Typical High
$288.40
Molina
Setting
Professional
Modifier
None
Typical Low
$204.17
Median
$331.13
Typical High
$416.87
Regence BlueShield
Setting
Facility
Modifier
None
Typical Low
$426.58
Median
$446.68
Typical High
$676.08
Regence BlueShield
Setting
Professional
Modifier
None
Typical Low
$323.59
Median
$323.59
Typical High
$323.59
Select Health
Setting
Facility
Modifier
None
Typical Low
$457.09
Median
$457.09
Typical High
$457.09
Select Health
Setting
Professional
Modifier
None
Typical Low
$229.09
Median
$446.68
Typical High
$457.09
U of Utah Health Plan
Setting
Professional
Modifier
None
Typical Low
$281.84
Median
$363.08
Typical High
$537.03
United
Setting
Professional
Modifier
None
Typical Low
$154.88
Median
$199.53
Typical High
$363.08

Where Utah sits

The same service costs 2.4 times more in Kansas than in Delaware. Every bar is a state, most expensive first. Touch or drag across it to read any state, then open that state for its carriers and full range.

Utah· 24th of 51

$288

KS $501DE $209

Median negotiated rate in each state, from every insurer that publishes one. States where no insurer publishes a rate for this service are not shown.