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Minnesota 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
$52.13 / $216.74 / $216.74
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$152.18 / $187.35 / $341.11
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$267.22 / $311.94 / $434.36
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$249.55 / $296.33 / $311.94
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$194.92 / $962.13 / $2,672.24
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$361.50 / $383.19 / $459.11
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$571.21 / $923.12 / $2,104.13
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$361.50 / $361.50 / $372.00
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$102.25 / $311.94 / $1,620.96
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$103.75 / $163.69 / $341.79
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$103.75 / $167.94 / $349.37