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Pennsylvania 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
$76.73 / $480.33 / $480.33
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.97 / $106.85 / $307.20
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$139.82 / $158.47 / $186.43
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,000.00 / $8,639.91 / $79,506.39
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$141.96 / $186.43 / $186.43
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$118.47 / $120.81 / $186.43
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$88.19 / $88.19 / $163.25
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$171.52 / $186.43 / $354.22
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$524.52 / $524.52 / $861.64
Highmark BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.90 / $132.86 / $158.47
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$76.73 / $480.33 / $480.33
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$76.73 / $106.85 / $239.56
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$73.00 / $95.90 / $367.30
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$118.47 / $120.81 / $186.43
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$88.19 / $88.19 / $221.63
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$135.71 / $177.45 / $177.45
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$135.71 / $177.45 / $181.83
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$73.45 / $94.85 / $162.90