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South Carolina 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
$77.62 / $81.28 / $162.18
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$141.25 / $181.97 / $363.08
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$158.49 / $251.19 / $331.13
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$190.55 / $316.23 / $389.05
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$147.91 / $194.98 / $549.54
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$141.25 / $141.25 / $363.08
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$154.88 / $208.93 / $229.09
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$162.18 / $263.03 / $537.03
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.20 / $30.20 / $223.87
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$154.88 / $181.97 / $426.58
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $162.18 / $208.93