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Alaska rates for HCPCS A5114

Leg strap; foam or fabric, replacement only, per set

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.42 / $23.42 / $23.42
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.51 / $7.51 / $7.51
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.38 / $7.51 / $7.74
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.42 / $3.42 / $3.42
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.10 / $23.38 / $36.92
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10.95 / $10.95 / $24.03
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.23 / $24.03 / $49.55
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.42 / $3.42 / $10.95
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.51 / $17.51 / $30.45
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.28 / $23.53 / $42.97