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Vermont 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
Professional
Modifier
Low / Median / High Price
$90.99 / $90.99 / $112.75
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$95.80 / $95.80 / $190.05
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$150.83 / $150.83 / $150.83
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$106.63 / $106.63 / $137.04
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$77.84 / $106.18 / $113.67
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$106.63 / $106.63 / $137.04
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$77.84 / $106.63 / $121.71
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$77.30 / $150.19 / $155.02