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New Mexico 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
$151.36 / $151.36 / $151.36
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$138.04 / $186.21 / $812.83
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$251.19 / $251.19 / $331.13
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$776.25 / $1,659.59 / $2,818.38
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$186.21 / $251.19 / $295.12
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$194.98 / $194.98 / $194.98
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$141.25 / $141.25 / $457.09
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$251.19 / $309.03 / $467.74
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $234.42 / $389.05
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$141.25 / $141.25 / $501.19
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$120.23 / $173.78 / $426.58
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$141.25 / $154.88 / $234.42