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Idaho rates for HCPCS L4387

Walking Boot Non-Pneumatic With Or Without Joints With Or Without Interface Material Prefabricated Off-The-Shelf

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$76.00 / $194.26 / $194.26
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$73.45 / $149.60 / $163.25
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$120.81 / $120.81 / $120.81
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$88.19 / $120.81 / $128.79
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$124.98 / $131.34 / $186.43
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$167.79 / $177.11 / $186.43
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $137.58 / $163.85
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$163.25 / $182.06 / $273.08
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$130.50 / $135.18 / $195.75
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$80.14 / $85.13 / $135.03