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Indiana 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
$187.80 / $187.80 / $379.44
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$187.80 / $202.37 / $239.57
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$280.00 / $284.58 / $368.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$299.76 / $339.60 / $379.44
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$185.11 / $230.17 / $317.63
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$322.52 / $417.38 / $569.16
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$322.52 / $417.38 / $512.24
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$225.12 / $237.10 / $379.44
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$173.08 / $237.10 / $389.24
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$126.20 / $189.30 / $279.52