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California rates for HCPCS A5114

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.35 / $3.67 / $36.09
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.67 / $5.45 / $36.09
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.51 / $5.43 / $14.35
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.32 / $6.09 / $10.13
Blue Shield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13.17 / $17.11 / $26.43
Blue Shield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.76 / $26.84 / $47.01
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.26 / $7.51 / $20.88
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.38 / $6.38 / $8.09
Contra Costa Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.00 / $12.50 / $15.00
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.50 / $8.75 / $19.38
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$75.00 / $80.00 / $80.00
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$108.14 / $110.75 / $110.75
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.42 / $11.05 / $12.66
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.38 / $7.51 / $10.63
Sutter Health Plus
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.60 / $23.60 / $23.60
The Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.00 / $10.00 / $11.25
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.76 / $5.30 / $12.29