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Utah rates for HCPCS L4361

Walking boot, pneumatic and/or vacuum, with or without joints, with or without interface material, prefabricated, off-the-shelf

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$134.90 / $134.90 / $134.90
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$144.54 / $263.03 / $977.24
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$213.80 / $213.80 / $213.80
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$154.88 / $154.88 / $251.19
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.67 / $245.47 / $316.23
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$251.19 / $295.12 / $512.86
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$186.21 / $239.88 / $363.08
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$302.00 / $338.84 / $416.87
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$245.47 / $346.74 / $512.86
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$128.82 / $154.88 / $165.96
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$123.03 / $154.88 / $245.47