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Arizona rates for HCPCS A5114

Leg Strap; Foam Or Fabric Replacement Only Per Set (Special Coverage Instructions Apply. See Mcm: 2130)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.50 / $7.50 / $22.50
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.91 / $7.50 / $28.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.30 / $11.94 / $21.58
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.26 / $11.01 / $15.00
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 / $6.38 / $8.58
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.42 / $8.94 / $80.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.18 / $5.30 / $7.98
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.49 / $5.30 / $7.98