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Utah rates for HCPCS L7405

Addition to upper extremity prosthesis, shoulder disarticulation/interscapular thoracic, acrylic material

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$251.19 / $251.19 / $251.19
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$251.19 / $457.09 / $3,715.35
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$630.96 / $630.96 / $630.96
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$457.09 / $457.09 / $660.69
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.26 / $645.65 / $831.76
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$660.69 / $776.25 / $1,348.96
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$489.78 / $630.96 / $912.01
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$794.33 / $891.25 / $912.01
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$645.65 / $912.01 / $1,047.13
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$323.59 / $512.86 / $588.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$309.03 / $389.05 / $588.84