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Virginia 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
$166.40 / $187.61 / $209.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$155.30 / $187.61 / $262.08
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$379.44 / $379.44 / $402.97
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$230.17 / $230.17 / $300.13
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$203.00 / $203.00 / $259.39
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 / $173.08 / $237.10
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$265.61 / $341.50 / $455.33
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$122.21 / $233.37 / $431.93
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$253.00 / $455.00 / $632.03
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$207.89 / $286.36 / $463.97
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$207.89 / $286.36 / $463.97
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$171.09 / $189.30 / $285.14