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Utah rates for HCPCS L7403

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

Facilitymedian $288 · 10th–90th $126–$4470%20%40%10th90th$288Professionalmedian $324 · 10th–90th $126–$1,9050%10%10th90th$324$50.0$100.0$200.0$500.0$1.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Small sample — interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $125.89
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $239.88 / $1,905.46
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$288.40 / $288.40 / $288.40
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$208.93 / $208.93 / $288.40
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$60.26 / $331.13 / $416.87
Regence BlueShield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$426.58 / $446.68 / $446.68
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$309.03 / $323.59 / $489.78
Select Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$436.52 / $446.68 / $457.09
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$323.59 / $457.09 / $537.03
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$165.96 / $263.03 / $295.12
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$154.88 / $199.53 / $331.13