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Illinois rates for HCPCS A5114

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.01 / $5.01 / $10.96
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.98 / $7.08 / $10.96
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.59 / $23.99 / $93.33
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.08 / $7.94 / $7.94
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.90 / $7.59 / $14.13
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.31 / $6.31 / $12.59
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.12 / $17.78 / $25.70
Hally Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.80 / $13.80 / $14.13
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.63 / $5.75 / $10.96
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.17 / $5.25 / $8.91