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Pennsylvania rates for HCPCS L3980

Upper extremity fracture orthosis, humeral, prefabricated, includes fitting and adjustment

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$145.28 / $145.28 / $562.23
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$132.66 / $170.01 / $282.41
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,000.00 / $8,639.91 / $79,506.39
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$268.80 / $353.01 / $353.01
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$229.50 / $229.50 / $389.70
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$167.54 / $167.54 / $341.24
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$358.52 / $389.70 / $740.43
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$366.45 / $366.45 / $1,631.54
Highmark BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$238.37 / $238.37 / $264.76
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$145.28 / $145.28 / $562.23
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$113.06 / $170.01 / $289.01
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$146.40 / $263.89 / $767.80
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$229.50 / $229.50 / $389.70
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$167.54 / $167.54 / $491.63
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$244.12 / $244.12 / $336.00
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$244.12 / $336.00 / $370.93
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$142.51 / $178.04 / $308.43