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Upper Extremity Fracture Orthosis, Humeral, Shoulder Cap

Utah rates for HCPCS L3981

Upper extremity fracture orthosis, humeral, prefabricated, includes shoulder cap design, with or without joints, forearm section, may include soft interface, straps, includes fitting and adjustments

Rates data updated July 2026.

Facilitymedian $490 · 10th–90th $427$1,1220%20%40%10th90th$490Professionalmedian $501 · 10th–90th $186$4,6770%10%10th90th$501$50.0$100.0$200.0$500.0$1.0K$2.0K$5.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$426.58
Median
$426.58
Typical High
$426.58
Aetna
Setting
Professional
Modifier
Global
Typical Low
$186.21
Median
$426.58
Typical High
$4,677.35
Cigna
Setting
Facility
Modifier
Global
Typical Low
$616.60
Median
$616.60
Typical High
$616.60
Cigna
Setting
Professional
Modifier
Global
Typical Low
$446.68
Median
$446.68
Typical High
$616.60
Molina
Setting
Professional
Modifier
Global
Typical Low
$60.26
Median
$812.83
Typical High
$1,071.52
Regence BlueShield
Setting
Facility
Modifier
Global
Typical Low
$1,071.52
Median
$1,122.02
Typical High
$1,122.02
Regence BlueShield
Setting
Professional
Modifier
Global
Typical Low
$616.60
Median
$794.33
Typical High
$1,202.26
Select Health
Setting
Facility
Modifier
Global
Typical Low
$1,148.15
Median
$1,148.15
Typical High
$1,148.15
Select Health
Setting
Professional
Modifier
Global
Typical Low
$575.44
Median
$1,096.48
Typical High
$1,148.15
U of Utah Health Plan
Setting
Professional
Modifier
Global
Typical Low
$812.83
Median
$1,148.15
Typical High
$1,318.26
United
Setting
Facility
Modifier
Global
Typical Low
$407.38
Median
$489.78
Typical High
$1,023.29
United
Setting
Professional
Modifier
Global
Typical Low
$389.05
Median
$489.78
Typical High
$831.76