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Michigan 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
$93.70 / $319.52 / $936.47
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$167.55 / $187.05 / $225.58
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$233.96 / $311.94 / $311.94
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$472.14 / $940.69 / $1,713.30
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$296.33 / $311.94 / $421.12
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$202.76 / $311.94 / $463.31
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$249.55 / $405.52 / $464.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$184.69 / $194.92 / $194.92
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$184.69 / $194.92 / $361.50
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$93.70 / $355.91 / $936.47
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$177.71 / $225.42 / $332.79
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$189.28 / $230.84 / $265.46
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$121.85 / $154.24 / $223.26