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Illinois 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
$194.98 / $194.98 / $389.05
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$169.82 / $229.09 / $467.74
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$223.87 / $295.12 / $346.74
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$457.09 / $741.31 / $2,630.27
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$245.47 / $288.40 / $288.40
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$223.87 / $234.42 / $257.04
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$173.78 / $173.78 / $436.52
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$323.59 / $436.52 / $575.44
Hally Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$489.78 / $489.78 / $489.78
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$199.53 / $199.53 / $288.40
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$162.18 / $302.00 / $616.60
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$147.91 / $190.55 / $316.23