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Indiana rates for HCPCS A5114

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10.71 / $10.71 / $12.50
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.87 / $6.75 / $10.71
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.09 / $6.09 / $11.75
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.32 / $6.09 / $8.40
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9.03 / $13.13 / $17.50
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.63 / $13.75 / $16.88
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.95 / $7.51 / $7.51
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.38 / $7.51 / $11.69
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.54 / $5.77 / $8.76