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Utah 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
$122.21 / $163.19 / $163.63
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$122.21 / $227.90 / $1,459.69
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$225.12 / $237.10 / $237.10
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$173.08 / $237.10 / $252.76
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$197.33 / $318.29 / $413.77
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$381.78 / $425.78 / $425.78
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$242.46 / $305.20 / $457.80
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$145.44 / $187.61 / $227.66