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Illinois 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
$5.97 / $5.97 / $5.97
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.96 / $6.13 / $10.95
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9.92 / $21.94 / $92.58
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.06 / $7.97 / $7.97
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.95 / $7.51 / $13.75
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.38 / $6.38 / $14.25
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.51 / $17.69 / $25.76
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
$13.82 / $13.82 / $14.16
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.05 / $14.46 / $15.95
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.15 / $5.30 / $9.11