go back

Utah rates for HCPCS L7404

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

Facilitymedian $437 · 10th–90th $195–$6760%20%40%10th90th$437Professionalmedian $490 · 10th–90th $195–$2,8180%5%10%10th90th$490$50.0$100.0$200.0$500.0$1.0K$2.0K

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
$194.98 / $194.98 / $194.98
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$194.98 / $363.08 / $2,818.38
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$436.52 / $436.52 / $436.52
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$316.23 / $316.23 / $436.52
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$60.26 / $489.78 / $630.96
Regence BlueShield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$645.65 / $676.08 / $676.08
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$467.74 / $489.78 / $741.31
Select Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$660.69 / $676.08 / $691.83
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$489.78 / $691.83 / $794.33
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$251.19 / $398.11 / $446.68
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$234.42 / $302.00 / $501.19