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Washington rates for HCPCS L3984

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

Facilitymedian $407 · 10th–90th $269–$9770%20%10th90th$407Professionalmedian $316 · 10th–90th $191–$6030%10%20%10th90th$316$1.0$5.0$20.0$100.0$500.0$2.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$269.15 / $269.15 / $630.96
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$190.55 / $269.15 / $588.84
Ambetter
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$295.12 / $389.05 / $426.58
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$346.74 / $389.05 / $389.05
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$346.74 / $346.74 / $446.68
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$223.87 / $234.42 / $234.42
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$173.78 / $173.78 / $234.42
Kaiser Permanente
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$239.88 / $537.03 / $1,122.02
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$239.88 / $489.78 / $870.96
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$75.86 / $302.00 / $331.13
Pacific Source
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$316.23 / $389.05 / $398.11
Pacific Source
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$316.23 / $398.11 / $398.11
Premera BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$346.74 / $575.44 / $794.33
Premera BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$331.13 / $331.13 / $389.05
Regence BlueShield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$389.05 / $389.05 / $389.05
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$346.74 / $346.74 / $446.68
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$186.21 / $512.86 / $616.60
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$177.83 / $218.78 / $363.08
Wellpoint
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$229.09 / $281.84 / $602.56