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California rates for HCPCS L3984

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$227.90 / $227.90 / $1,459.69
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$197.61 / $227.90 / $485.00
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$227.66 / $266.94 / $338.97
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$173.06 / $712.94 / $1,605.94
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$185.11 / $230.17 / $373.71
Blue Shield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$97.00 / $598.97 / $1,069.58
Blue Shield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.00 / $671.28 / $1,563.63
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$225.12 / $237.10 / $270.44
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$173.08 / $173.08 / $252.76
Contra Costa Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$168.89 / $202.67 / $556.51
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$303.55 / $354.14 / $769.00
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$733.58 / $2,002.53 / $2,403.12
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,428.42 / $2,428.42 / $3,044.40
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$816.76 / $816.76 / $816.76
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$122.21 / $405.66 / $505.92
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$173.08 / $237.10 / $398.78
Sutter Health Plus
Facility/Professional
Professional
Modifier
Low / Median / High Price
$954.89 / $954.89 / $954.89
The Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$168.89 / $287.11 / $404.74
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$171.89 / $189.30 / $481.36