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Utah rates for HCPCS L7404

Addition To Upper Extremity Prosthesis Above Elbow Disarticulation Acrylic Material

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$193.05 / $193.05 / $193.05
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$193.05 / $212.18 / $1,889.59
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$434.07 / $434.07 / $434.07
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$316.87 / $434.07 / $462.74
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$307.03 / $495.22 / $643.78
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$593.99 / $662.46 / $662.46
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$377.22 / $474.85 / $712.28
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$270.01 / $299.04 / $429.01