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Montana 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
Professional
Modifier
Low / Median / High Price
$147.91 / $213.80 / $776.25
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$457.09 / $75,857.76 / $95,499.26
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$331.13 / $331.13 / $331.13
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$194.98 / $354.81 / $354.81
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$141.25 / $288.40 / $354.81
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$257.04 / $331.13 / $645.65
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$257.04 / $331.13 / $645.65
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$186.21 / $331.13 / $407.38
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $263.03 / $398.11
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$154.88 / $158.49 / $194.98
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$141.25 / $154.88 / $177.83