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Missouri 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
$239.88 / $245.47 / $275.42
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$162.18 / $234.42 / $501.19
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$281.84 / $338.84 / $346.74
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$467.74 / $467.74 / $1,621.81
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$223.87 / $234.42 / $426.58
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$281.84 / $281.84 / $467.74
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$208.93 / $234.42 / $234.42
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$173.78 / $173.78 / $234.42
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$213.80 / $371.54 / $1,995.26
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$151.36 / $229.09 / $2,454.71
Qualchoice
Facility/Professional
Professional
Modifier
Low / Median / High Price
$371.54 / $371.54 / $371.54
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$169.82 / $363.08 / $363.08
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$151.36 / $213.80 / $323.59