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Illinois 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
$160.33 / $228.62 / $389.76
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$142.66 / $187.34 / $311.94
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$223.03 / $233.96 / $233.96
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$372.06 / $629.46 / $2,683.99
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$184.30 / $237.07 / $237.07
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$184.69 / $194.92 / $343.13
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$142.29 / $194.92 / $361.50
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$265.14 / $343.13 / $467.91
Hally Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$405.52 / $405.52 / $405.52
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$176.09 / $251.57 / $264.14
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$129.69 / $155.62 / $267.14