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Maine rates for HCPCS L3984

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$208.17 / $250.69 / $289.20
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$423.75 / $549.01 / $1,017.70
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$230.17 / $242.14 / $242.14
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$237.10 / $237.10 / $350.19
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$173.08 / $173.08 / $237.10
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$385.76 / $385.76 / $385.76
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$227.90 / $268.27 / $289.20
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$158.46 / $237.70 / $546.62