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Maine rates for HCPCS L4387

Walking boot, nonpneumatic, with or without joints, with or without interface material, prefabricated, off-the-shelf

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$47.85 / $47.85 / $113.15
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$89.12 / $111.17 / $113.16
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$165.81 / $214.82 / $398.21
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$108.19 / $108.19 / $112.34
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 / $88.19 / $120.81
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$150.94 / $150.94 / $150.94
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$47.85 / $47.85 / $47.85
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$106.85 / $111.17 / $113.16
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$66.66 / $95.81 / $213.92