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Above Elbow Disarticulation, Acrylic Material

Utah rates for HCPCS L7404

Addition to upper extremity prosthesis, above elbow disarticulation, acrylic material

Rates data updated October 2026.

How much does Above Elbow Disarticulation, Acrylic Material cost?

$437

Typical negotiated rate. In Utah, October 2026.

Insurers have agreed to pay about $437 for this service. The price depends on where it is billed: about $437 from a physician practice, and about $437 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$437$302 to $490
FacilityA hospital or hospital-owned outpatient department$437$195 to $676

How much rates vary

Facilitymedian $437 · 10th to 90th $195 to $676Professionalmedian $437 · 10th to 90th $195 to $617
$100$200$500$1Kfacility $437professional $437

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
$194.98
Median
$194.98
Typical High
$194.98
Aetna
Setting
Professional
Modifier
None
Typical Low
$194.98
Median
$194.98
Typical High
$213.80
Cigna
Setting
Facility
Modifier
None
Typical Low
$436.52
Median
$436.52
Typical High
$478.63
Cigna
Setting
Professional
Modifier
None
Typical Low
$316.23
Median
$316.23
Typical High
$436.52
Molina
Setting
Professional
Modifier
None
Typical Low
$309.03
Median
$489.78
Typical High
$630.96
Regence BlueShield
Setting
Facility
Modifier
None
Typical Low
$645.65
Median
$676.08
Typical High
$1,023.29
Regence BlueShield
Setting
Professional
Modifier
None
Typical Low
$489.78
Median
$489.78
Typical High
$489.78
Select Health
Setting
Facility
Modifier
None
Typical Low
$691.83
Median
$691.83
Typical High
$691.83
Select Health
Setting
Professional
Modifier
None
Typical Low
$346.74
Median
$660.69
Typical High
$691.83
U of Utah Health Plan
Setting
Professional
Modifier
None
Typical Low
$426.58
Median
$549.54
Typical High
$794.33
United
Setting
Professional
Modifier
None
Typical Low
$234.42
Median
$302.00
Typical High
$549.54

Where Utah sits

The same service costs 2.2 times more in Montana 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· 25th of 51

$437

MT $708DE $316

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.