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New Hampshire 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
$109.45 / $109.45 / $131.34
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.00 / $109.45 / $155.10
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$186.43 / $186.43 / $186.43
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$186.43 / $186.43 / $220.99
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$108.19 / $112.34 / $112.34
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$118.47 / $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 / $465.91
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$62.01 / $92.18 / $116.74
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$115.63 / $140.08 / $199.10