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Utah rates for HCPCS L7403

Addition To Upper Extremity Prosthesis Below Elbow/Wrist Disarticulation Acrylic Material

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$127.91 / $127.91 / $127.91
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$127.91 / $140.58 / $1,251.91
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$286.80 / $286.80 / $286.80
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$209.36 / $209.36 / $520.40
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$203.42 / $328.10 / $426.53
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$393.55 / $438.91 / $438.91
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$249.93 / $314.61 / $471.91
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$178.90 / $198.13 / $276.77