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New York rates for HCPCS L4386

Walking Boot Non-Pneumatic With Or Without Joints With Or Without Interface Material Pre- Fabricated Item That Has Been Trimmed Bent Molded Assembled Or Otherwise Customized To Fit A Specific Patient By An Individual With Expertise(Revised 01/01/14)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$63.47 / $89.79 / $150.19
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.47 / $102.50 / $268.55
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$144.03 / $144.03 / $144.03
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$186.43 / $190.16 / $372.86
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$103.75 / $103.75 / $288.98
CDPHP
Facility/Professional
Facility
Modifier
Low / Median / High Price
$144.46 / $155.33 / $155.33
CDPHP
Facility/Professional
Professional
Modifier
Low / Median / High Price
$155.33 / $155.33 / $155.33
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$106.63 / $106.63 / $121.71
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$77.84 / $77.84 / $121.71
Emblem Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$186.43 / $319.00 / $419.47
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$109.99 / $139.82 / $339.68
Excellus BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$112.10 / $119.10 / $155.33
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$106.63 / $121.71 / $555.00
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$77.84 / $87.21 / $246.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$62.01 / $99.32 / $160.69
Univera
Facility/Professional
Facility
Modifier
Low / Median / High Price
$112.10 / $112.10 / $124.58
Univera
Facility/Professional
Professional
Modifier
Low / Median / High Price
$112.10 / $112.10 / $119.10