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New Hampshire 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
$234.19 / $281.02 / $597.83
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$140.83 / $181.73 / $234.91
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$415.92 / $415.92 / $493.03
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$189.42 / $189.42 / $199.06
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$184.69 / $194.92 / $194.92
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$142.29 / $142.29 / $207.79
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$336.75 / $336.75 / $1,039.38
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$138.33 / $207.50 / $266.36
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$271.75 / $326.10 / $490.51