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Idaho 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
$162.18 / $162.18 / $162.18
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$162.18 / $245.47 / $380.19
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$316.23 / $380.19 / $645.65
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$426.58 / $446.68 / $446.68
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$234.42 / $234.42 / $316.23
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$173.78 / $173.78 / $234.42
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$123.03 / $346.74 / $467.74
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$239.88 / $380.19 / $407.38
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.20 / $30.20 / $338.84
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$380.19 / $389.05 / $389.05
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$281.84 / $309.03 / $446.68
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$316.23 / $407.38 / $446.68
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$138.04 / $213.80 / $251.19
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$173.78 / $190.55 / $263.03