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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 July 2026.

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

$263

Typical negotiated rate. In Utah, July 2026.

Insurers have agreed to pay about $263 for this service. The price depends on where it is billed: about $263 from a physician practice, and about $263 from a hospital or other facility. The two figures are alternatives, not parts of one bill.

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.

Where it's billed changes the price

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$263$182 to $457
FacilityA hospital or hospital-owned outpatient department$263$129 to $447

How much rates vary

Facilitymedian $263 · 10th to 90th $129 to $447Professionalmedian $263 · 10th to 90th $129 to $1,905
$50.0$100.0$200.0$500.0$1.0Kfacility $263professional $263

Distribution of negotiated rates across all payers (price axis is log-scale). Each curve is scaled to its own total: facility and professional rates are different services, shown together to compare where they cluster. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$128.82
Median
$128.82
Typical High
$128.82
Aetna
Setting
Professional
Modifier
Global
Typical Low
$128.82
Median
$194.98
Typical High
$1,905.46
Cigna
Setting
Facility
Modifier
Global
Typical Low
$288.40
Median
$288.40
Typical High
$288.40
Cigna
Setting
Professional
Modifier
Global
Typical Low
$208.93
Median
$208.93
Typical High
$288.40
Molina
Setting
Professional
Modifier
Global
Typical Low
$60.26
Median
$331.13
Typical High
$416.87
Regence BlueShield
Setting
Facility
Modifier
Global
Typical Low
$426.58
Median
$446.68
Typical High
$446.68
Regence BlueShield
Setting
Professional
Modifier
Global
Typical Low
$251.19
Median
$323.59
Typical High
$489.78
Select Health
Setting
Facility
Modifier
Global
Typical Low
$457.09
Median
$457.09
Typical High
$457.09
Select Health
Setting
Professional
Modifier
Global
Typical Low
$229.09
Median
$446.68
Typical High
$457.09
U of Utah Health Plan
Setting
Professional
Modifier
Global
Typical Low
$323.59
Median
$457.09
Typical High
$537.03
United
Setting
Facility
Modifier
Global
Typical Low
$165.96
Median
$263.03
Typical High
$316.23
United
Setting
Professional
Modifier
Global
Typical Low
$154.88
Median
$199.53
Typical High
$302.00

Where Utah sits

The same service costs 2.7 times more in Kansas than in Nebraska. Every bar is a state, most expensive first. Pick one to see its carriers and full range.

Utah $263 · 24th of 51
KS $525NE $195

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.