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Michigan 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
$216.70 / $216.70 / $570.73
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$203.80 / $227.90 / $278.10
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$284.58 / $284.58 / $284.58
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$574.30 / $1,144.24 / $2,084.04
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$360.47 / $379.44 / $512.24
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$246.64 / $246.64 / $292.14
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$303.55 / $303.55 / $303.55
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$225.12 / $237.10 / $237.10
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$225.12 / $237.10 / $439.88
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$216.70 / $274.20 / $570.73
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$216.69 / $274.20 / $405.37
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$230.24 / $280.79 / $322.90
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$148.22 / $181.40 / $271.58