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Arizona rates for HCPCS L4360

Walking Boot Pneumatic And/Or Vacuum With Or Without Joints With Or Without Interface Materialprefabricated Item That Has Been Trimmed Bent Molded Assembled Or Otherwise Customized To Fit A Specific Patient By An Individual With Expertise(Revised 01/01/14)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$220.50 / $258.52 / $258.52
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$145.58 / $187.34 / $438.39
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$272.95 / $272.95 / $272.95
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$51.18 / $184.90 / $334.30
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$127.95 / $170.60 / $260.33
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$194.92 / $194.92 / $194.92
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$142.29 / $142.29 / $361.50
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.47 / $253.63 / $1,620.96
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$140.51 / $155.62 / $234.42
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$140.51 / $155.62 / $234.42