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Maine 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
$100.19 / $100.19 / $100.19
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$181.73 / $206.08 / $252.46
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$369.92 / $479.26 / $888.41
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$189.42 / $199.06 / $199.06
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$194.92 / $194.92 / $305.69
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$142.29 / $142.29 / $194.92
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$336.75 / $336.75 / $336.75
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.19 / $100.19 / $100.19
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.46 / $234.19 / $252.46
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$138.33 / $207.50 / $477.18