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Alaska rates for HCPCS L4360

Walking boot, pneumatic and/or vacuum, with or without joints, with or without interface material, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.90 / $229.09 / $389.05
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$169.82 / $213.80 / $363.08
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$194.98 / $194.98 / $194.98
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$141.25 / $141.25 / $208.93
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $316.23 / $354.81
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$281.84 / $380.19 / $794.33
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$363.08 / $363.08 / $371.54
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$295.12 / $363.08 / $371.54
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $371.54
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.26 / $194.98 / $398.11
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$154.88 / $154.88 / $158.49
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$177.83 / $275.42 / $912.01